GBV Response in FP RH Trainers Manual en

Integrating Gender-
Based Violence Response

into Family Planning and
Reproductive Health
Service Delivery
TRAINER’S MANUAL
I NTE G RA T IN G G BV - R ESP O NS E IN TO FP A N D RH S ER VI CE DE L IV ER Y | TR A IN ER ’S MA NU A L
Integrating Gender-Based Violence

Response into Family Planning and
Reproductive Health Service Delivery
TRAINER’S MANUAL
2
Suggested Citation: Accelerating Universal Access to Family Planning/Shukhi Jibon Project. Integrating GBV-
Response into Family Planning and Reproductive Health Service Delivery: Trainer’s Manual. (Dhaka: Pathfinder
International, 2023).
This manual was developed by Pathfinder International with support from USAID through the Accelerating
Universal Access to Family Planning project, also known as Shukhi Jibon, and from the David and Lucile Packard
Foundation through the Cox’s Bazar Sexual and Reproductive Health and Rights project.
This document is made possible by the support of the American people through the United States
Agency for International Development (USAID). The contents are the sole responsibility of Pathfinder International
and do not necessarily reflect the views of USAID or the United States Government.
3
Contents
CONTENTS .............................................................................................................................................................................. 3
PREFACE ................................................................................................................................................................................. 4
ACKNOWLEDGEMENTS ........................................................................................................................................................... 7
CONTRIBUTORS ...................................................................................................................................................................... 8
BACKGROUND .......................................................................................................................................................................10
NOTES TO TRAINER ................................................................................................................................................................11
OVERVIEW OF TRAINING........................................................................................................................................................22
MODULE 0: INTRODUCTION TO TRAINING .............................................................................................................................23

MODULE 0 TOOLS AND HANDOUTS .......................................................................................................................................26
MODULE 1: UNDERSTANDING GENDER AND GBV ..................................................................................................................32
MODULE 2: FOUNDATIONS IN GBV ........................................................................................................................................57

MODULE 3: GBV-RESPONSIVE FP AND SRH SERVICE PROVISION.............................................................................................89
MODULE 3 TOOLS AND HANDOUTS ..................................................................................................................................... 114

MODULE 4: FOUNDATIONAL KNOWLEDGE OF GBV CASE RECORDING, DOCUMENTATION, AND RECORD KEEPING .............. 126
MODULE 5: CLOSING ............................................................................................................................................................ 134
REFERENCES ......................................................................................................................................................................... 143
Note: A copy of the PowerPoint Slide Decks 1 and 2 are attached at the end of this manual for convenience.
3
Preface
Message from the Director General, Directorate General of Family Planning
At the Nairobi Summit (ICPD+25) in 2019, the Government of

Bangladesh identified three issues to have been "zero tolerance"—
maternal mortality, unmet need for family planning, and gender-
based violence (GBV). GBV is a global phenomenon.
In Bangladesh, as shown in the Report of Violence Against Women (VAW) Survey 2015, 72.5 percent of women
face any form of violence during their lifetime, and 36.1 percent of women said their husbands expect them to get
their permission to access health services. Compounding these issues, many women are not receiving the support
they need, which contributes to the significant challenges: unmet need for family planning (12%), discontinuation
rate of family planning methods (37%), and grave incidence of child marriage (50%).1
The Directorate General of Family Planning (DGFP) has had tremendous success in increasing contraceptive
prevalence rate (CPR) and decreasing total fertility rate (TFR) in the years after its independence. But women and
girls in Bangladesh are facing high gender disparity and disequilibrium. One in four (24%) women ages 15–19 have
ever been pregnant, and almost one in five (18%) have had a live birth.2 The high fertility rate among adolescents
(72/1,000 LB) aged between 15–19 and the high maternal mortality ratio (168/100,000 LB)3 demand adequate,
intensive action. In addition to enhancing the capacity of Bangladesh’s family planning workforce, it is imperative
to take action to reduce the gender gap as well as GBV. And this requires addressing the underlying factors; for
example, strengthening facility readiness and building workforce capacity in responding to gender- and GBV-
related issues.
Many issues could be redressed if we work diligently on GBV and sexual and reproductive health and rights (SRHR).
To achieve this, there are areas to be addressed, e.g., increasing service providers’ understanding of gender and
GBV, minimizing the gap in service delivery, sharing information, and providing GBV-related knowledge to the
clients. Moreover, in Bangladesh, we have a paucity of adequate data relating to GBV as part of family planning
and SRH services.
This manual, “Integrating Gender-Based Violence (GBV) Response into the Family Planning and Reproductive
Health Services” will help end critical gaps. This resource, which will strengthen the capacity of Bangladesh’s family
planning service providers to identify, record, and assist the management of GBV cases, has been developed
through the concerted efforts of the DGFP; the Directorate General of Health Services (DGHS); the National
Institute of Population Research and Training (NIPORT); and the USAID-funded-, Pathfinder-led Shukhi Jibon
project, in collaboration with the Packard Foundation.
I would like to express my sincere gratitude and appreciation to all who have extended their support for the entire
effort in the development and formulation of this resource. Special thanks to all those involved in the Pathfinder
International for their well-timed cooperation.
1 National Institute of Population Research and Training (NIPORT) and ICF. “Bangladesh Demographic and Health Survey 2022: Key Indicators Report.” (Dhaka,
Bangladesh, and Rockville, Maryland, USA: NIPORT and ICF, 2023).

2 NIPORT and ICF, BDHS 2022.
3Bangladesh Bureau of Statistics, Statistics and Informatics Division, Ministry of Planning, Government of the People’s Republic of Bangladesh, Report on
Bangladesh Sample Vital Statistics (SVRS) 2020, (Dhaka, Bangladesh) 2021.
4
Using this manual, Bangladesh’s family planning service providers will better be able to provide appropriate, high-
complied, gender-sensitive services, which are very crucial for a quality program. I hope and believe that all the
service providers and managers involved in the family planning program will make the best use of this valuable
resource to create a happy, healthy, and violence-free atmosphere addressing all the relevant issues.
Shahan Ara Banu, ndc

Director General (Grade 1)
Directorate General of Family Planning
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Message from Director of Finance and Line Director of Family Planning - Field Service Delivery, DGFP
The family planning program in Bangladesh is a milestone activity. In the
last fifty years, the TFR in Bangladesh has decreased from 5.21 in 1982 to
2.04 in 2019,4 the CPR has increased from 8 percent in 1975 to 63
percent in 2017, and the unmet need has decreased from 17 percent in
2007 to 12 percent in 2017.5
However, as per the spirit of various survey reports, there is yet a huge scope to decrease TFR at the targeted base
and improve the quality of service to meet the demands of service recipients.
GBV remains a global issue that is frequently and consistently exacerbated in times of stress and crisis. Global
estimates by the World Health Organization (WHO) and other UN agencies indicate that one in three women, and
one in ten men, will experience sexual violence in their lifetime. As many as two in three women will experience
intimate partner violence (IPV), and as many as 30 percent of girls have a non-consensual sexual debut.
Bangladesh is no exception.
During the implementation of various programs, it has been seen that even though the service providers have
ideas about gender and GBV, they do not have a clear understanding of its connection to family planning services
or why integrating GBV response into family planning and reproductive health service delivery is important. In
some cases, service providers do not easily understand that their clients are being subjected to GBV while seeking
family planning or other reproductive health services. Providers may think GBV is normal, and they have no
responsibility to intervene.
I offer my gratitude to Pathfinder International for taking this timely step, considering these contexts, and taking
the initiative to prepare this manual “Integrating Gender-Based Violence Response into Family Planning and
Reproductive Health Service Delivery” for Bangladesh’s family planning service providers. The manual is a joint
venture between DGFP, DGHS, NIPORT, the Multisectoral Program on Violence Against Women (MSPVAW), the
Ministry of Women and Children Affairs (MOWCA), representatives of the WHO, UN Women, and the Shukhi Jibon
project. My gratitude also to the DGFP, DGHS, NIPORT, and everyone from Pathfinder International who has been
involved in supporting the development of this manual, which was finalized through a working group.
Through proper use of this manual, Bangladesh’s family planning service providers will be able to increase their
knowledge and skills—to determine, treat, and refer to GBV issues related to sexual and reproductive health and
family planning. This manual will make it easier to ascertain that violence exists in family planning and sexual and
reproductive healthcare-related services and will help achieve family planning indicators, such as improving CPR,
reducing dropout of family planning methods, reducing unmet need, etc. This is a joint venture and will help
ensure that service providers offer the highest quality care.
Md. Sohel Parves

Director (Finance) and Line Director (Family Planning – Field Services Delivery)
Directorate General of Family Planning
4 Bangladesh Bureau of Statistics, Report on Bangladesh Sample Vital Statistics (SVRS) 2020, (Dhaka, Bangladesh) 2021.
5Bangladesh Bureau of Statistics, Statistics and Informatics Division, Ministry of Planning, Government of the People’s Republic of Bangladesh, Report on Violence
Against Women Survey 2015 (Dhaka, Bangladesh) 2016.
6
Acknowledgements
Message from Project Director of USAID Shukhi Jibon and Country Director of Pathfinder International
Recognizing the critical role family planning service providers can play
in maximizing the sexual and reproductive health (SRH) sector’s
capacity to provide first-line response and secondary prevention of
GBV through the integration of services and improved referral systems,
Pathfinder International is pleased to present this new skill-building
resource: “Integrating Gender-Based Violence Response into the Family Planning and
Reproductive Health Services—a training manual.”
Everyone has a right to SRH and to live a life free from violence. Yet for too many women and girls in Bangladesh,
GBV restricts their mobility, access to resources and health care, and decision-making power. GBV is a grave
violation of human rights with far reaching impacts, including for family planning and SRH outcomes. A majority of
service providers encounter issues of GBV in the line of duty, but many do not recognize its symptoms or may lack
training on how to integrate first-line response into family planning or SRH services.
This resource addresses an urgent need within our public health system, providing the first-ever GBV-specific
training for family planning providers available in Bangla. Pathfinder developed this manual with funding from
USAID through the Accelerating Universal Access to Family Planning project, also known as Shukhi Jibon, and from
the David and Lucile Packard Foundation through the Cox’s Bazar Sexual and Reproductive Health and Rights
project. This manual presents GBV topics clearly and thoroughly, so even providers who have never before
incorporated GBV into their work will be able to put this information to use—to expand their knowledge and skills
and improve the quality of services they deliver to family planning clients living with GBV.
On behalf of the entire Shukhi Jibon project, the Packard Foundation, and Pathfinder International, I offer our deep
thanks to Bangladesh’s DGFP, DGHS, NIPORT, the Multisectoral Program on Violence Against Women (MSPVAW),
MOWCA; WHO; UN Women; and the working group on GBV with family planning services for their commitment to
developing this critical resource.
Most of all, Pathfinder offers enormous gratitude to the health providers, family planning clients, and many
survivors of GBV who bravely come forward to ask for help and share their stories, whose journeys informed the
work on which this manual was built.
Md. Mahbub Ul Alam

Project Director, USAID Shukhi Jibon, and
Country Director, Pathfinder International Bangladesh
7
Contributors
Manual Review Committee
CONVENERS
Md. Sohel Parves, Line Director, Field Service Delivery Unit, Directorate General of Family Planning (DGFP)
Md. Niajur Rahman, Ex-Line Director, Field Service Delivery Unit, DGFP
MEMBERS
Dr. Nasreen Akhter, Deputy Director, Primary Health Care (PHC), Directorate General of Health Services (DGHS)
Zakia Akhter, Deputy Director, Audit Unit, DGFP
Indrani Debnath, Deputy Program Manager, Field Service Delivery Unit, DGFP
Zinnat Ara, Assistant Director (Foreign Procurement), Logistics, and Supply Unit; DGFP
Sayeda Umme Kaosar Ferdousi, Senior Instructor, National Institute of Population Research and Training (NIPORT)
Halima Begum, Program Officer, Multi-Sectoral Program on Violence Against Women, Ministry of Women and Children
Affairs (MOWCA)
Mst. Tosiba Kashem, Program Analyst, Ending Violence Against Women Program, UN Women
Suraiya Akter, Team Assistant, Immunization and Vaccine Development and Gender Focal, World Health Organization
(WHO) Bangladesh
MEMBER SECRETARY
Dr. Shamima Parveen, Manager - Gender, USAID Shukhi Jibon, Pathfinder International
Content Development, Editorial, and Production Support
Md. Mahbub Ul Alam, Project Director, USAID Shukhi Jibon, and Country Director, Pathfinder International
Caroline Crosbie, Senior Advisor, USAID Shukhi Jibon, Pathfinder International
Dr. Sharmin Sultana, Technical Director/FP Specialist, USAID Shukhi Jibon, Pathfinder International
Dr. Fatema Shabnam, Adolescent and Youth Specialist, USAID Shukhi Jibon, Pathfinder International
Matiur Rahman, Assistant Director (Coordination), DGFP
Rebecca Herman, Senior Technical Advisor for Gender-Based Violence and Maternal and Newborn Health, Pathfinder
International
Maren Vespia, Strategic Communications/External Affairs, Pathfinder International
Dr. Nazneen Akhter, Consultant, Pathfinder International
Marufa Aziz Khan, Manager, Knowledge Management and Learning, USAID Shukhi Jibon, Pathfinder International
Ridwanul Mosrur, Manager, Communications and Documentation, USAID Shukhi Jibon, Pathfinder International
Halima Akhtar, Program Coordinator, USAID Shukhi Jibon, Pathfinder International
Olivia Moseley, Instructional Design Consultant, Pathfinder International
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Acronyms and Abbreviations

AIDS Acquired immunodeficiency syndrome
ANC Antenatal care
BDHS Bangladesh Demographic and Health Survey
CHCP Community health care service providers
CHW Community health worker
CPR Contraceptive prevalence rate
CEDAW Convention on the Elimination of All Forms of Discrimination against Women
FWV Family welfare visitors
FPI Family planning inspector
FP Family planning
FWA Family welfare assistant
FWC Family welfare center
GBV Gender-based violence
GIFPS Gender-integrated family planning services
HTSP Healthy timing and spacing of pregnancy
HIV Human immunodeficiency virus
IGWG Interagency Gender Working Group
ICPD International Conference on Population and Development
IUD Intrauterine device
LAPM Long-acting or permanent method
MCH Maternal and child health
MOWCA Ministry of Women and Children Affairs
OCC One-stop crisis center and/or cell
PTSD Post-traumatic stress disorder
PPT PowerPoint presentation
RTI Reproductive tract infection
SRHR Sexual and reproductive health and rights
STI Sexually transmitted infection
TFR Total fertility rate
TBA Traditional birth attendant
UHC Upazila health complex
UNFPA United Nations Fund for Population Activities
UNICEF United Nations International Children's Fund
USAID United States Agency for International Development
VAW Violence against Women
WHO World Health Organization
9
Background
For more than a quarter of a century, the global community has recognized gender-based violence
(GBV) as a human rights violation as well as a complex social challenge that presents in multiple forms
and contexts. The 1993 United Nations (UN) Declaration on Elimination of Violence Against Women
defines GBV as “any act that results in, or is likely to result in, physical, sexual or psychological harm or
suffering [on the basis of gender], including threats of such acts, coercion or arbitrary deprivations of
liberty, whether occurring in public or private life.”
GBV remains a global issue that is frequently and consistently exacerbated in times of stress and crisis.
Global estimates by the World Health Organization (WHO) and other UN agencies indicate that one in
three women6 will experience sexual violence in their lifetime. As many as two in three women will
experience intimate partner violence (IPV), and as many as 30 percent of girls have a non-consensual
sexual debut.7 Bangladesh is no exception. Thirty-one percent of women ages 20–49 reported that they
were married by age 15.8 An estimated fifty percent of ever-married/partnered women ages 15–39 have
experienced IPV in their lifetime.9 These forms of GBV frequently intersect with reproductive coercion
and contraceptive sabotage.10 While Bangladesh-specific data is unavailable, global evidence suggests
that as many as one in four women will experience a form of contraceptive sabotage in her lifetime.11
Since 2016, WHO has outlined clear evidence, strategies, and entry points for the health-sector response
to violence against women and girls. Notably, the Global Plan of Action for Health System Response to
Violence Against Women and Girls12 highlights the unique role that health providers—particularly sexual
and reproductive health (SRH) care providers—play as an extra-familial, professional point of contact.
Furthermore, the report highlights that, globally, those most affected by violence are more likely to
need and use health services. Yet, SRH providers and service managers are often ill-supported and
undertrained to recognize violence, build confidence and competence in discussing violence, and
provide first-line response to clients in need of help.
The Accelerating Universal Access to Family Planning Project, popularly known as Shukhi Jibon, is
working to help close this gap. Funded by USAID and led by Pathfinder International, Shukhi Jibon
supports the government of Bangladesh to deploy skilled, responsive, and respectful providers who
deliver high-quality family planning (FP) and SRH services. This includes strengthening public-sector
capacity in GBV integrating GBV-response into FP and RH service delivery.
6 WHO. Violence against Women Prevalence Estimates, 2018. Global, regional and national prevalence estimates for intimate partner violence against women and
global and regional prevalence estimates for non-partner sexual violence against women (Geneva: 2021).
7 Claudia Garcia-Moreno, et. al. “WHO Multi-country Study on Women's Health and Domestic Violence against Women Study Team. Prevalence of intimate partner
violence: findings from the WHO multi-country study on women's health and domestic violence.” Lancet. 2006; 368 (9543): 1260–1269.
8 National Institute of Population Research and Training (NIPORT), and ICF. Bangladesh Demographic and Health Survey 2017-18: Key Indicators (Dhaka, Bangladesh,
and Rockville, Maryland, USA: 2019).

9 WHO, Violence against women prevalence estimates, 2018 – WHO South-East Asia Region Fact Sheet (Geneva: 2021).
10 Contraceptive sabotage is the deliberate interference with agreed use of contraception.
11Rowlands S, Walker S. (2019). “Reproductive control by others: means, perpetrators and effects.” BMJ Sexual & Reproductive Health; 45:61-67:
https://srh.bmj.com/content/45/1/61.
12 WHO Department of Reproductive Health and Research. Global Plan of Action: Health systems address violence against women and girls (Geneva: 2016).
10
Notes to Trainer
Training Goals and Objectives
Overall Goal
This two-day training aims to advance the knowledge and skill set of FP and SRH service providers to
address GBV and provide GBV-responsive care.
Learning Outcomes
1. Gain a greater understanding and knowledge of gender norms, dynamics, equity, and their role in
GBV.
2. Gain a greater understanding of how GBV manifests in FP and SRH service provision and uptake.
3. Increase knowledge of how GBV is relevant to FP services, including GBV risk identification and
analysis.
4. Gain skills to mitigate and respond to GBV threats within the context of FP and sexual and
reproductive health and rights (SRHR) activities.
5. Master skills required to deliver the first three steps of the LIVES pneumonic13 for disclosure
response.
6. Gain knowledge on how to refer GBV survivors to appropriate service providers/facilities in a safe
and ethical way.
7. Develop skill sets to manage GBV case recording and reporting during FP and SRH service provision.
This training is not intended to develop providers’ skills required to provide comprehensive medical care
for GBV, nor the skills required to provide clinical management of rape. Rather, this training is intended
to give FP and SRH providers the skills needed to integrate GBV-responsive care into their routine work
as FP and SRH services providers.
13 WHO. Health care for women subjected to intimate partner violence or sexual violence: A clinical handbook (Geneva: 2014).
11
Suggestions for Using This Manual

Timing
The curriculum allows trainers/facilitators to formulate their own training schedule based on local time
and training needs. Each module can be used independently, but the curriculum works best when used
in its entirety. The modules can also be lengthened or shortened depending on the level of training and
expertise of the participants. As currently presented, the training content requires 13 hours and five
minutes (not including meals and breaks) and would be suitable for a 2-day training.
Participant Selection
The manual is available in English and Bangla languages and can be delivered to family planning health
care workers of any cadre. The module was designed with health care providers in mind, but it can also
be used as supplementary reference material for gender training and self-directed learning by a wide
range of professionals in the health system, both at institutional and facility levels.
Organization of the Manual and Training

This training contains five modules:
• Module 1: Introduction to Training
• Module 2: Understanding Gender and GBV
• Module 3: GBV-Responsive FP and SRH Service Provision
• Module 4: Foundational Knowledge of GB Case Recording, Documentation, and Record Keeping
• Module 5: Closing
Each module addresses specific learning objectives. At the beginning of each module, you will find
guidance on the materials needed, advance preparation required, and additional resources, as well as an
overview of the sessions. Activities and content presentations are spread out throughout the modules.
Content and supplementary information are incorporated into trainer instructions, while participant
handouts and trainer’s tools are included at the end of each module.
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Guide to Symbols
Symbols are used throughout the manual to help guide and instruct trainers. These symbols include:
TOTAL SESSION/MODULE TIME

Estimated time needed for each module or session. All times listed are suggested and subject to
change depending on participant learning needs.
TRAINER NOTE
Additional notes or guidance on how a particular issue or session should be dealt with.
LEARNING OBJECTIVES
What participants can expect to achieve during the training, module, or session.
METHODOLOGIES
Training methods used in the module, for example, discussions or case studies.
MATERIALS NEEDED
Materials needed to teach the module, for example, flipchart and markers.
ADVANCE PREPARATION
Planning and preparation for a session or exercise that should be undertaken in advance.
REFERENCES
Additional background information, guidelines, books, journals, websites, and other documents
that may be useful to trainers/facilitators who want more information on topics or issues related
to a specific module’s content.
FOR GROUP DISCUSSION

A list of questions for participants to reflect on or consider.
13
PowerPoint Presentation
The PowerPoint (PPT) slide sets were developed to facilitate presentations and discussions throughout
the training and are available as separate slide decks. Deck 1 contains slides for Modules 0–2 and Deck 2
contains slides for Module 3–5.
Evaluation
The Tool A: Pre-/Post-test Assessment is designed to assess knowledge gained as a result of the
training. The tests are identical, except that the pre-test is administered before the start of the training
and the post-test at the end of the training.
Participants do not need to write their names on either the pre- or post-test (i.e., it can be completed
anonymously). However, as you will need to compare each participant’s post-test score with his/her
pre-test score, ask each participant to put a 3- or 4-digit number or code at the top of the pre-test. This
can be any number or code, such as a favorite number (e.g., 777), year of birth (1962), or code (ABC*). It
is very important that participants remember this number or code, as they will need to record the exact
same number/code at the top of their post-test. When administering the pre-test, suggest that they
write their number/code on the copy of the training schedule—this way they will not forget it.
You will also ask participants to complete a training evaluation form at the end of the training. This
evaluation form is an important source of feedback and provides much information on how the training
could be improved in the future to better meet participant training needs. Upon completion of the
training, take at least a half hour to read through the training evaluation forms. Focus on the questions
where the ratings were relatively low and think through how these areas can be strengthened in the
future. Think of ways to address suggestions offered in response to “How can we improve this training?”
particularly if mentioned by multiple participants.
Materials Needed
• Trainer’s Manual
• Participant’s Manual
• PPT slides to accompany each module
• Laptop computer, projector, and screen to show PPT (for all modules)
• Participant handouts and Trainer Tool (located at the end of each module)
• Flipchart papers, easel, and markers
• Index cards
• Sticky notes/post-it notes
• Pens and paper
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Guidance on Facilitating Discussion of GBV Issues

To facilitate open and nonjudgmental discussions, trainers should take time to:
• Consider their own assumptions and biases. Take time to consider your opinions about GBV and
why you hold them.
• Practice using neutral language (this includes gender-neutral language) and avoid making
judgments about “right” or “wrong” behavior. Participants may share stories of behavior that is
not evidence-based. It is important to applaud them for sharing and honesty so that open
reflection and growth can take place during the training.
The role of the trainer in a participatory session is one of guidance, not authority. The training should be
a learning journey that participants and trainers take together, not a one-off delivery of information
from expert to audience. While there are content presentations included in the manual, the trainer
should always strive to achieve a dialogue with participants.
Setting Ground Rules for GBV Discussions

Before starting the training, work with participants to agree to set of “ground rules.” Because of the
sensitive nature of discussions on GBV, the ground rules should emphasize:
• Privacy and confidentiality for participants
• Using nonjudgmental language in the training space
• Allowing space for reaction and emotion
• Admitting when you do not know something
• Treating each other with respect
• Creating space for each person to speak
• Acknowledgement of personal experiences of violence and the potential for participants to need
referral to services of their own
It is good practice to post the list of ground rules in the room where participants can see them, and
periodically revisit them during the training.
15
Preparatory Work
Each module in this curriculum has information about work to be done in advance for the sessions in
that module. You—the trainer/facilitator or co-trainers/facilitators—should familiarize yourselves with
all components of this curriculum well in advance of the training.
The Trainer’s Manual was developed to support trainers/facilitators and co-trainers/facilitators to plan
and implement the training. At the beginning of each module, you will find Learning Objectives,
Methodologies, Materials Needed, Resources, Advance Preparation, and Module/Session Time (see
Guide to Symbols above). Each session and activity also include the estimated amount of time required
for that activity.
Before conducting the training, you should read through this introductory section carefully. Review the
principles of adult learning, suggestions for trainers/facilitators, description of the role of the
trainer/facilitator, trainer/facilitator checklist, and tips on managing time, managing difficult
participants, and communicating effectively. Then study each of the modules, read the technical content
to ensure you understand it, review the exercises closely, take note of exercises that require advance
preparation, and try to anticipate participant questions.
Each module includes exercise, such as large group discussion, case studies, small group work, and
roleplays. Instructions, including recommended timeframes, for each exercise can be found in the
exercise instructions.
ü Be flexible; be ready to change exercises or the order of the agenda to adapt to the needs of
participants and the amount of time available.
ü Become familiar with the PPT slides prior to the training by reviewing them several times and
comparing them with the module content. You may even want to practice using the slides by
presenting a session, or even a module, to colleagues or just on your own. The better you know
the content, understand the learning methods, and master the computer equipment and
projector, the more confident you will feel!
ü Review the content, in particular the case studies and roleplays, to ensure local and contextual
relevance.
ü Case studies can be removed or modified to reflect local content.
ü Names can and should be changed to reflect common local names.
ü Trainers/facilitators can add new case studies based on local statistics, cultural practices, social
traditions, and common health issues.
ü Review the PPT presentations and flow of the session.
ü Print all participant handouts and trainer tools needed for the sessions.
ü Gather any additional materials needed.
For some sessions, trainers/facilitators may want to consider:
ü Preparing flipcharts with some information already written on them.
ü Rearranging chairs or the training space to allow room for particular activities.
ü Doing some additional research and preparation on local laws, policies, or context.
16
P COMPLETE THE FOLLOWING BEFORE STARTING EACH MODULE

Read curriculum objectives, technical content, and teaching exercises.
Prepare for each of the exercises according to the Trainer’s Instructions.
Obtain or develop and organize the materials needed.
Read the content and the suggestions for facilitating group discussion. Add your own questions or tips
that will help you engage participants and ensure that key messages are discussed.
Review the PowerPoint slides and become familiar with their content. Practice using the computer and
projector and practice presenting technical content using the slides. Practice on your own or find
friends or colleagues who are willing to be “participants.”
Practice! It is not always easy to explain group exercises or to draw responses from an audience. Be
prepared by thinking ahead and developing strategies. For complicated exercises or discussions,
consider co-facilitation.
Have a plan for monitoring time and keeping to the schedule.
Have a plan for coping with difficult or disruptive participants.
Choose a technique for creating small groups. If this is done multiple times during the day, choose a
different method for each instance, unless it is specified that groups should remain the same.
Learn what you can about participants before the training (for example, their worksite, roles,
responsibilities, skills, and experience). This effort should continue throughout the training.
Ask to yourself and your facilitation team: Are we ready to start two days GBV training? Yes/No
If you answer “No,” please read the manual instructions carefully again.
17
Key Principles of Adult Learning Theory14

• Respect – Adult students must feel respected and feel like equals.
• Affirmation – Adult students need to receive praise, even for small attempts.
• Experience – Adult students learn best by drawing on their own knowledge and experience.
• Relevance – Learning must meet the real-life needs of adults for their work, families, etc.
• Dialogue – Teaching and learning must go both ways, so that the students enter into a dialogue
with the teacher.
• Engagement – Adult students must engage with the material through dialogue, discussion, and
learning from peers.
• Immediacy – Adult students must be able to apply the new learning immediately.
• 20-40-80 Rule – Adult students typically remember 20% of what they hear, 40% of what they
hear and see, and 80% of what they hear, see, and do.
• Thinking, feeling, and acting – Learning is more effective when it involves thinking, feeling
(emotions), and acting (doing).
• Safety and comfort – Adult students need to feel safe and comfortable in order to participate
and learn. They need to know that their ideas and contributions will not be ridiculed or belittled.
This curriculum is firmly grounded in a participatory approach to learning. The sessions benefit learning
through interactive activities, discussions, and small group work. Participatory learning methodologies
help learners build their knowledge and skills through shared reflection, critical analysis, and collective
problem solving.
14 Partners in Health (PIH), Training of Trainers: A manual for training facilitators in participatory teaching techniques (Boston: PIH, 2011).
18
DOs and DON’Ts of Training

The following should always be kept in mind by the trainer/facilitator in any learning session:
Do:
ü Maintain good eye contact.
ü Prepare in advance.
ü Involve participants.
ü Use visual aids where possible.
ü Speak clearly, loudly, and slowly.
ü Encourage questions.
ü Admit when you do not know an answer and commit to revisiting it.
ü Recap at the end of each session.
ü Bridge one topic to the next.
ü Encourage participation.
ü Write clearly and legibly.
ü Summarize.
ü Reflect participants’ reactions back to them.
ü Use good time management.
ü Give constructive and positive feedback.
ü Be aware of the participants’ body language and level of participation.
ü Provide clear instructions.
ü Check to see if your instructions are understood.
ü Evaluate and adjust as you go.
ü Be patient, understanding, and empathetic.
Don’t:
û Talk to the flipchart or slide presentation.
û Block the visual aids.
û Stand in one place (it’s helpful to move around the room).
û Ignore participants’ questions, comments, or feedback.
û Force anyone to participate.
û Shout at or criticize participants.
û Dismiss participant’s beliefs or opinions.
û Let factually incorrect, biased, or judgmental statements go uncorrected.
û Let one strong participant dominate conversation.
19
The Training Cycle

Identify
needs
Design
Evaluate
training
Apply Develop
learning training
Deliver
training
For effective training, remember the following:
• A training helps trainee master a specific set of skills through a direct (or “hands-on”)
interaction.
• It is critical to first understand the need for the training and design the sessions to create the
best scenario/ knowledge and skill base to address this need.
• The whole facilitation process should be practical and application-oriented, so the trainees can
apply their new knowledge and skills into a real work situation.
• Training is a continuum of knowledge, skill, competency feed to trainees, so the facilitator’s role
is to develop desire and aspiration.
20
Tips for Training as a Team

When planning a module presentation with another trainer/facilitator, discuss the following questions
to help clarify your roles:
• Which parts of the module would you like to be responsible for?
• Which parts would you like your colleague to handle?
• What is your teaching style? How does your teaching style differ from that of your colleague?
• What challenges might arise? How can you and your colleague ensure that you will work well
together?
• What signal could you and your colleague use to interrupt when the other person is presenting?
• How will you handle staying on task?
• How will you field participant questions?
• How will you make transitions between each of your presentations?
• How will you get participants back from breaks in a timely manner?
21
Overview of Training
Day 1 Duration
MODULE 0: Introduction to Training

Session 0-A: Introductions, Group Norms, and Pre-test 30 min.
Total Module Time 30 min.
MODULE 1: Understanding Gender and GBV
Session 1-A: Understanding Gender in FP Services 1 h. 30 min.
Session 1-B: Gender Relevance in FP Success and Failure 1 h.
Total Module Time 2 h. 30 min.
MODULE 2: Foundations of GBV
Session 2-A: Understanding and Conceptualizing GBV 45 min.
Session 2-B: GBV Risk Analysis in FP and SRHR 45 min.
Session 2-C: Male Engagement in GBV Prevention Awareness 30 min.
Session 2-D: Understanding GBV in FP and SRH for Adolescents and Youth 1 h. 10 min.
Session 2-E: Day 1 Wrap Up 40 min.
Total Module Time 3 h. 50 min
DAY 1 TOTAL TRAINING TIME* 6 h. 50 min.
Day 2 Duration
MODULE 3: GBV-Responsive FP and SRH Service Provision

Session 3-A: GBV-Responsive Counseling in FP and SRHR 1 h. 30 min.
Session 3-B: Responding to Disclosures of GBV 1 h.
Session 3-C: Making GBV Referrals 1 h. 30 min.
Total Module Time 4 h.
MODULE 4: Foundational Knowledge of GBV Case Recording, Documentation, and Record Keeping
Session 4-A: Legality, Protecting Confidentiality, and Reporting GBV 45 min.
Total Module Time 45 min.
MODULE 5: Closing
Session 5-A: Closing Session and Post-Test 1h. 30 min.
Total Module Time 1 h. 30 min.
DAY 2 TOTAL TRAINING TIME* 6 h. 15 min.
TOTAL TRAINING TIME 13 h. 05 min.
*Note: Does not include lunch or other breaks (two hours for two days)
22
Module 0: Introduction to Training

The introductory module provides the overview of the training, including objectives and methodologies.
It is also an opportunity to create an enabling environment for learning, respect, and active participation
in the training. This module includes a pre-test. The purpose of the pre-test is not to evaluate the
knowledge of the participants, but rather to enable facilitators to structure the sessions and their
explanations accordingly. It will also serve to measure the group’s change in knowledge, when
compared to the results of the post-test administered at the end of the training.
TOTAL MODULE TIME: 30 MIN.

• Session 0-A: Introductions, Group Norms, and Pre-test
LEARNING OBJECTIVES
Participants will be able to:
• Get to know each other.
• Gain a clear understanding of the overall goal and objectives of this training.
• Agree on ground rules and norms for training.
• Assess baseline knowledge via pre-test.
METHODOLOGIES
• Presentation
• Assessment
MATERIALS NEEDED
• Flipchart and markers
• Trainer PPT Slide Deck 1
• Index cards
• Tool A: Pre-test Assessment
• Participant list
• Nametags
ADVANCE PREPARATION
• Review slides and training content
• Prepare training room
23
MO DU L E 0: I NTR O DUC TI O N TO TR A IN IN G
Session 0-A: Introductions, Group Norms, and Pre-test
30 MIN.
Activity 1: Welcome
Welcome and Introduction of Trainers (5 min.)
TRAINER NOTE
Prepare the training room as follows:
• Ensure projection equipment is working and the Day 1 PPT slide deck is loaded.
• Have a minimum of two flip chart stands ready at the front of the room. Write a welcome
message on one. On the other, write instructions for each participant to take materials upon
entering.
• On a second page of one of the flip charts, write out the ground rules as found on PAGE 15 of
this manual.
• Place participant manuals, printed copies of the pre-test, name tags, a registration sheet, and
index cards on a table at the entrance to the training space.
• Prepare and place instructions for the expectations cards by the materials table.
Participants should write 1–2 expectations for the training on a card and hand them to a
facilitator as they arrive and get settled.
Step 1
Ask participants to take their seats and offer a warm greeting. Remind participants they should be filling
out an expectations card and to please do so now, if they have not already completed one.
One facilitator should go around, collecting outstanding cards, while the welcome and introduction
continues.
Step 2
Welcome the participants into the training room and introduce yourself and all facilitators to the
participants.
Step 3
Turn to the ground rules page of your flip chart and review the ground rules for this training. Ask if any
participant has any other norms or ground rules to request/suggest to the group.
24
Activity 2: Presentation
Overall goal, objectives, and learning outcomes (5 min.)
STEP 1
Present PPT SLIDES 2–5.
When presenting SLIDE 5, explain the following:
This training is not intended to develop the skills required to provide comprehensive medical care
for GBV, nor the skills required to provide clinical management of rape. Rather this training is
intended to give you the skills needed to integration GBV responsive care into your routine work
as SRH service providers. When in doubt, always bring in or refer clients to specialized providers
or points of care.
Activity 3: Assessment
Pre-Test (20 min.)
Step 1
Distribute Tool A: Pre-test Assessment.
Step 2
Inform participants that the pre-test is intended to help facilitators structure the sessions over the next
two days in a way that is most helpful to them. Let them know that there will be a post-training
assessment, including both a knowledge assessment and a skills assessment component, at the end of
the training.
TRAINER NOTE
Participants do not need to write their names on either the pre- or post-test (it can be completed
anonymously). However, as you will need to compare each participant’s post-test score with their pre-
test score, ask each participant to write a unique 3- or 4-digit number or code at the top of the pre-test.
This can be any number or code, such as a favorite number (e.g., 777), or code (ABC*). It is very
important that participants remember this number or code, as they will need to record the exact same
number/code at the top of their post-test. When taking the pre-test, suggest that they write their
number/code on the copy of the training schedule—this way they will not forget it.
The skills assessment will only take place at the end of the training and is not conducted during this
activity.
25
Module 0 Tools and Handouts

Tool A: Pre- and Post-Test Assessment
Participant’s unique code: _______________ Date: ___________
1. True or False? Indicate if the below statements about gender and family planning are true or false
by circling “true” or “false” for each statement. (5 points total; 0.5 each)
a) True / False – Decision-making power and access to resources affect women’s ability to obtain
and continue using family planning.
b) True / False – Reproductive coercion (threatening, harassing, or forcing someone to have or not
have a child) is a form of gender-based violence.
c) True / False – The signs of gender-based violence are always easy for a provider to see.
d) True / False – One of the key principles guiding gender-sensitive client-provider interaction is
“do not harm.”
e) True / False – Gender is the sex difference between men and women.
f) True / False – Gender is the social difference between men and women
g) True / False – “Gender equity” and “gender equality” mean the same thing.
h) True / False – Gender inequalities are barriers in family planning.
i) True / False – Adolescents and youth age are in the same age group.
j) True / False – “999” is the number of National Emergency Service Bangladesh.
2. Do the following items refer to gender or sex? Tick the appropriate answer. (2 points)
Gender Sex
Menstruation
Women should do all the cooking
Breastfeeding
Wet dreams
Men are natural leaders
Women can get pregnant
26
3. What is the definition of “gender equity”? Circle the correct answer. (1 point)
a) Providing the same resources to women and men.
b) Ignoring a person’s gender.
c) The process of being fair to women, men, and those with diverse gender identities, according to
their diverse needs.
d) Legal rights are given to women.
4. What can impact a woman’s or a girl’s access to family planning, as well as her choice of method
and ability to use it? Circle the correct answer. (1 point)
a) Violence and/or fear of violence.
b) Pressure on women and couples to “prove” fertility soon after marriage.
c) The taboo on women and girls accessing reproductive health information.
d) All of the above.
5. Violence against women and girls is: Circle the correct answer. (1 point)
a) An effective way to correct behaviors.
b) A private family matters.
c) Any act that is based on gender norms or unequal power dynamics that results in, or is likely to
result in, physical, sexual, or mental harm to women.
d) None of the above.
6. Which of the following is an appropriate opportunity to involve men in family planning? Circle the
correct answer. (1 point)
a) A client says she would like her male partner to be present for family planning counseling.
b) A male client is interested in family planning methods he can use.
c) A male community leader says he wants to help young couples understanding the benefits of
family planning.
7. Which two abbreviations are correct? Circle the correct answers. (1 point)
a) GATHER: Greet – Acquire information – Teach – Help – Experience – Refer
b) GATHER: Greet – Ask – Tell – Help – Explain – Recommend a return
c) LIVES: Listen – Inquire – Validate – Enhance safety – Support
d) LIVES: Listen – Initiate – Validate – Educate – Serve
27
8. True/False - Child Marriage refers to the marriage of a girl before the age of 18. (1 point)
9. True/False - 109 is a 24/7 National Helpline Centre for Violence against Women and Children. (1
point)
10. Which of the following points do you consider incorrect in the following referral checklist?
Circle your answer. (1 point)
a) Advocate for and support survivors in accessing services
b) Lead case coordination
c) Provide direct services to the scope and designation of your role and facility
d) Make specific referrals relevant to where a client lives
11. What type of gender-based violence occurred in this case? Circle the correct answer. (3 points)
Sushila (pseudonym), age 24, is an RMG worker at a garment factory at Ashulia. Sushila has learned that
she is pregnant. She formally notifies her supervisor using the proper procedure and requests approval
of maternity leave. However, her supervisor is upset at the thought of losing a good worker and having
to pay benefits. The supervisor tells Sushila that if she just gets MR, this will not be a problem, and she
can continue to earn good money to help her family. Sushila is distraught and consults with her husband
about the matter. Her husband tells her she must quit her job, or he will stop giving her bus money.
a) Reproductive coercion
b) Intimate partner violence
c) Workplace harassment
d) All of the above
SCORE: /18 POINTS
28
Tool B: Pre- and Post-Test Answer Key

1. True or False? Indicate if the below statements about gender and family planning are true or false
by circling “true” or “false” for each statement. (5 points total; 0.5 each)
a) True / False – Decision-making power and access to resources affect women’s ability to obtain
and continue using family planning.
b) True / False – Reproductive coercion (threatening, harassing, or forcing someone to have or not
have a child) is a form of gender-based violence.
c) True / False – The signs of gender-based violence are always easy for a provider to see.
d) True / False – One of the key principles guiding gender-sensitive client-provider interaction is
“do not harm.”
e) True / False – Gender is the sex difference between men and women.
f) True / False – Gender is the social difference between men and women
g) True / False – “Gender equity” and “gender equality” mean the same thing.
h) True / False – Gender inequalities are barriers in family planning.
i) True / False – Adolescents and youth age are in the same age group.
j) True / False – “999” is the number of National Emergency Service Bangladesh.
2. Do the following characteristics refer to gender or sex? Tick the appropriate answer. (2 points)
Characteristics Gender Sex
Menstruation X
Women should do all the cooking X
Breastfeeding X
Wet dreams X
Men are natural leaders X
Women can get pregnant X
3. What is the definition of “gender equity”? Circle the correct answer. (1 point)
a) Providing the same resources to women and men.
b) Ignoring a person’s gender.
c) The process of being fair to women, men, and those with diverse gender identities, according
to their diverse needs.
d) Legal rights are given to women.
29
4. What can impact a woman’s or a girl’s access to family planning, as well as her choice of method
and ability to use it? Circle the correct answer. (1 point)
a) Violence and/or fear of violence.
b) Pressure on women and couples to “prove” fertility soon after marriage.
c) The taboo on women and girls accessing reproductive health information.
5. Violence against women and girls is: Circle the correct answer. (1 point)
a) An effective way to correct behaviors.
b) A private family matters.
c) Any act that is based on gender norms or unequal power dynamics that results in, or is likely
to result in, physical, sexual, or mental harm to women.
d) None of the above.
6. Which of the following is an appropriate opportunity to involve men in family planning? Circle the
correct answer. (1 point)
a) A client says she would like her male partner to be present for family planning counseling.
b) A male client is interested in family planning methods he can use.
c) A male community leader says he wants to help young couples understanding the benefits of
family planning.
7. Which two abbreviations are correct? Circle the correct answers. (1 point)
a) GATHER: Greet – Acquire information – Teach – Help – Experience – Refer
b) GATHER: Greet – Ask – Tell – Help – Explain – Recommend a return
c) LIVES: Listen – Inquire – Validate – Enhance safety – Support
d) LIVES: Listen – Initiate – Validate – Educate – Serve
8. True / False – Child Marriage refers to the marriage of a girl before the age of 18. (1 point)
9. True / False – 109 is a 24/7 National Helpline Centre for Violence against Women and Children. (1
point)
30
10. Which of the following points do you consider incorrect in the following referral checklist?
Circle your answer. (1 point)
a) Advocate for and support survivors in accessing services
b) Lead case coordination
c) Provide direct services to the scope and designation of your role and facility
d) Make specific referrals relevant to where a client lives
11. What type of gender-based violence occurred in this case? Circle the correct answer. (3 points)
Sushila (pseudonym), age 24, is an RMG worker at a garment factory at Ashulia. Sushila has learned that
she is pregnant. She formally notifies her supervisor using the proper procedure and requests approval
of maternity leave. However, her supervisor is upset at the thought of losing a good worker and having
to pay benefits. The supervisor tells Sushila that if she just gets MR, this will not be a problem, and she
can continue to earn good money to help her family. Sushila is distraught and consults with her husband
about the matter. Her husband tells her she must quit her job, or he will stop giving her bus money.
a) Reproductive coercion
b) Intimate partner violence
c) Workplace harassment
d) All of the above
SCORE: /18 POINTS
31
Module 1: Understanding Gender and GBV

TOTAL MODULE TIME: 2 H. 30 MIN.
• Session 1-A: Understanding Gender in FP Services
• Session 1-B: Gender Relevance in FP Success and Failure
LEARNING OBJECTIVES
• Gain clear concepts of gender, gender equity and equality, and their impact on power and
violence.
• Identify gender discrimination issues and practices in FP and SRH settings and society.
• Gain insights into gender’s role in FP success and failure.
• Articulate the relevance of gender-discrimination and GBV to optimize FP and SRH services.
METHODOLOGIES
• Presentation
• Reflection
• Discussion
• Case study
MATERIALS NEEDED
• Case Studies 1–5
ADVANCE PREPARATION
32
MO DU L E 1: UN DER ST A NDI NG GE ND ER A ND G B V
Session 1-A: Understanding Gender in FP Services
1 H. 30 MIN.
Activity 1: Presentation and Reflection

Introduction, Objectives, and Gender Reflection (15 min.)
STEP 1
Present the learning outcomes on SLIDE 7. After presenting this information, be sure to note:
A separate training on Gender-Integrated Family Planning Service is available. If you have not
taken that training, please consider speaking with your supervisor and/or facility manager about
participating in an upcoming cohort.
STEP 2
Project SLIDE 8 and ask participants, “What does gender mean to you?”
Direct participants to turn to a person near them and take turns sharing reflections based on the
following three prompts:
1. Share a time when you became aware of your gender.
2. Think of a time when you felt happy about your gender.
3. Has there been a time when you felt scared, discriminated against, or sad because of your
gender?
STEP 3
Present SLIDE 9 and note the following:
It’s important to remember that gender is socially constructed and separate from biological sex
which is determined by genetics and most commonly identified through congenital anatomy.
STEP 4
Present SLIDE 10 focused on inequality.
Women are half the world’s population. Yet, women live with a 3x greater lifetime experience of
gender-based violence. In low- and middle-income countries, gender discrimination results in an
estimated 3.9 million excess deaths among women and girls by the age of 60.15,16
15 World Bank. World Bank Group Gender Strategy (FY16-23): Gender Equality, Poverty Reduction and Inclusive Growth (Washington, DC: 2015).
16 World Bank. World Development Report 2012: Gender Equality and Development (Washington, DC: 2011).
33
Activity 2: Reflection
Gender Quiz (10 min.)
STEP 1
Project SLIDE 11 and say: “So let’s see how much you already know about the differences between
gender and sex.”
STEP 2
Direct participants to turn to the Gender Quiz on page 16 in their Participant’s Manual.
Ask participants to read each statement below carefully. Then check the appropriate box to answer the
question: Does this issue relate to sex, or does it relate to gender?
Instruct participants to complete the four-question quiz quietly and independently. After a few minutes,
review the correct answers all together—as a group—asking for volunteers to share what answers they
selected and why.
GENDER QUIZ
Tick the correct box
Gender Sex
1. Women must consume extra calories and safe water during
lactation.
2. It is a man’s responsibility to protect his family’s honor.
3. Female-bodied people will need resources and space to enable
optimal menstrual hygiene.
4. Women and girls have a responsibility to ensure they don’t get
pregnant or have sex before they are married.
TRAINER NOTES
The following notes relate to each answer of the gender quiz:
1. Because these nutritional needs are physiological and based in biology, they are related to a
person’s sex.
2. Concepts of responsibility and honor are constructed by society and change over time. This a
gender-based norm.
3. Female-bodied people menstruate due to their biological sex.
4. Concepts of morality, marriage, and appropriate timing for pregnancy differ from one culture to
another and change over time. These are gender-based and social values.
34
Gender and Biological Sex (15 min.)
STEP 1
Present SLIDE 12 on the differences between gender and sex, noting the following:
Gender and sex are not the same. While sex is generally permanent and universal, gender
construction varies from one society to another.
Gender Sex
Socially constructed roles, responsibilities, and Physically, biologically defined

attitudes (e.g., division of labor)
Gender rules and regulations are learned/imposed; Determined by birth; we are born with it
we build it in our own minds
Differences in dress and behavior Determine our physical functions
Differences between and within cultures, includes Same throughout the world
variables identifying differences in roles,
responsibilities, attitudes, opportunities,
expectations, needs, and constraints
Changeable over time Generally unchangeable
35
REFERENCE: DEFINITIONS
From WHO:
Gender refers to socially constructed characteristics of women and men—such as norms, roles,
and relations of and between groups of women and men.17
Sex refers to the biological characteristics that define humans as female or male. While these sets
of biological characteristics are not mutually exclusive, as there are individuals who possess both,
they tend to differentiate humans as males and females.18
From USAID, Interagency Gender Working Group (IGWG):19

Gender is a culturally defined set of economic, social, and political roles, responsibilities, rights,
entitlements, and obligations associated with being female and male, as well as the power
relations between and among women and men, boys, and girls. The definition and expectations of
what it means to be a woman or girl and a man or boy, and sanctions for not adhering to those
expectations, vary across cultures and over time, and often intersect with other factors such as
race, class, age, and sexual orientation. Transgender individuals, whether they identify as men or
women, are subject to the same set of expectations and sanctions.
Sex is classification of people as female, male, or intersex. At birth, infants are assigned a sex
based on a combination of bodily characteristics including chromosomes, hormones, internal
reproductive organs, and genitalia.
Definitions from Pathfinder International:20

Gender is about the roles, norms, and behaviors that society consider appropriate for women,
men, girls, boys, and those with diverse gender identities, such as transgender. These are socially
constructed and vary widely within and across cultures, religions, class, and ethnicity. For
example, in many societies a common gender norm is that women and girls should do most of the
domestic work.
Sex is typically assigned at birth and refers to the biological characteristics that define humans as
female, male, or intersex.
17 WHO. Gender mainstreaming for health managers: a practical approach (Geneva: 2011).
18 “Sexual health: definitions,” WHO, accessed January 20, 2023, https://www.who.int/health-topics/sexual-health#tab=tab_2.
19 “Handout: Gender-related Terms and Definitions,” IGWG, accessed January 23, 2023, https://www.igwg.org/wp-
content/uploads/2017/05/HandoutGenderTerms.pdf.
20 For more information, visit https://www.pathfinder.org/focus-areas/gender/
36
STEP 2
Present SLIDES 13–14.
KEY GBV-RELATED TERMS AND CONCEPTS
Gender Norms
What society considers male and female behavior, leading to the formation of gender roles,
which are the roles men and women, and boys and girls, are expected to take in society.
Gender Awareness
An awareness of the differences in roles and relations between women and men. It recognizes
that the life experiences, expectations, and needs of women and men are different, varying
across the culture and society.
Gender Equity
The absence of discrimination based on a person’s sex or gender. Gender equity means
providing the same opportunity to each person, including access to and control of social,
economic, and political resources, including protection under the law, such as health services,
education, and voting rights.
Gender Discrimination
Any distinction, exclusion, or restriction made on the basis of socially constructed gender roles
and norms, which prevents a person from enjoying full human rights.
Gender-Related Barriers
Obstacles to access and use of health services, which are related to deep-rooted social and
cultural norms about the roles of women, men, and those with diverse gender identities.
Gender-Based Violence (GBV)

Any act that is perpetrated against a person’s will and is based on gender norms and unequal
power relationships. This includes threats or acts of coercion, arbitrary deprivation of liberty,
neglect, or discrimination, whether occurring in public or in private life. GBV encompasses
physical or sexual assault, emotional or psychological harm, denial of resources or access to
services, and denial of legal self-autonomy.
When presenting SLIDE 14, emphasize the following to participants:

Please note that gender discrimination and gender-based violence are two separate things.
While many forms of gender discrimination enable and/or are perpetuated by gender-based
violence (e.g.: laws that require women to comply with their husband’s requests for intimate
relationships regardless of their desire in a given moment); there are forms of GBV that would
not qualify as gender discrimination (e.g., physical intimate partner violence).
Gender discrimination entails systematic and/or policy-based behaviors that place one gender at
a disadvantage over another. Gender-based violence may occur as an isolated incident.
37
REFERENCE: GENDER EQUALITY VS GENDER EQUITY

• Gender equality is the absence of discrimination based on a person’s sex or gender. It
means providing the same opportunity to each person, including access to and control of
social, economic, and political resources, including protection under the law (such as
health services, education, and voting rights).
• Gender equity is the process of being fair to women, men, and those with diverse gender
identities. It recognizes that men and women have different needs, power, and access to
resources, which should be identified and addressed in a manner that rectifies the
imbalances. Addressing gender equity leads to equality. For example, an affirmative action
policy adopted by a health facility to increase the number of women in senior leadership
posts may be gender-equitable because it leads to ensuring equal rights among men and
women.
• The goal of gender equality is not for women and men, girls, and boys, to become the
same. The goal of gender equality is to ensure that women and men have the same
chances to access and benefit from social, economic, and political resources (e.g., have the
same opportunities to vote, to be educated).
• The goal of gender equity moves beyond equality to strive toward equality of outcomes.
Thus, it moves beyond considering women and men as being equal under the law to
ensuring that conditions will not block their equal participation in health promotion
activities. It recognizes, for example, that women and men may have different needs,
preferences, and interests, and that achieving equality of opportunity (e.g., gender
equality) may require treating women and men differently and/or separately.
• Gender equality differs from gender equity in that gender equity is about how health
services meet different population needs, whereas gender equality is about making sure
that everyone is given the same services.
GENDER EQUALITY GENDER EQUITY
• Equality means sameness • Equity means fairness

• Giving everyone the same • Access to the same opportunity
• It works if everyone starts from the • We must first ensure equity before
same place we can enjoy equality
An Example of Equality vs. Equity
38
Activity 4: Presentation, Case Study, and Group

Discussion
Understanding Gender and Power (50 min.)
STEP 1
Present SLIDE 15, which focuses on power and covers the following information:
UNDERSTANDING GENDER AND POWER

Power is the capacity or ability to direct or influence the behavior of self, others, or the course
of events.
Power Over
An individual or institution’s degree of power translates to their capacity to exploit others,
regardless of intention or action to do so.
Power To
An individual or institution’s capacity to create without using relationships of domination. The
capacity to act and to exercise agency and realize the potential of goals, rights, or aspirations.
Power Within
A person’s sense of their own capacity and self-worth. It is related to the productive sense of
‘power to’ and a prerequisite to holding or increasing one’s ‘power to.’
Power With
Collective power within, to, or over that comes from intentional solidarity amongst individuals
or groups. This collective power can be mobilized both within and across class, caste, religious,
gender and age differences.
Share the following with participants:

The case study we are going to look at next helps unpack how a person’s power or lack of power
influences their FP choices, service seeking, and SRH outcomes.
Historically, power was understood as something one either had or did not have. More recent
conceptualization from the fields of sociology, psychology, and gender studies have helped us
understand that people and groups of people may have certain forms of power, but not others.
This provides valuable insight into how to empower someone even if they are in a vulnerable
position or part of a marginalized group.
39
TRAINER NOTE
This is a new and challenging framework for many. Be sure to pause for questions and expect them.
Here are some examples that may help clarify these power dynamics:
• Parents have power over their children, which they can use in a positive way to teach
responsibility through chores, household contributions, etc. Parents can also use power over
their children in an exploitative or negative way (e.g.: forced, early marriage). Children rarely
have power over others, but they may have power to ask their parents for help or to inform a
teacher if another student is harassing them.
• Power within is a pre-requisite to having power to act. Think of power within as the fuel for
agency. It is important to realize that someone may have power within, such as a young
woman who is confident in her right to complete school and advocates for herself in that
regard, but not have the power to actually do something (e.g.: legally, her parents may be
permitted to withhold permission for her to complete secondary school).
• It is valuable to remember that a person who has little to no power on their own can still have
or develop power with others. As health workers, you may be able to help someone living
with GBV who has little to no power within, power to act for their safety, or power over
others identify groups or individuals with whom they can find some power to change their
circumstances. Power with is often a critical form of power for enacting change to address
GBV at a community, societal, or systems level.
40
STEP 2
Project SLIDE 16.
Share the following information to participants:

When considered together, understanding power dynamics helps one understand the following:
1. GBV is any action, threat, or exercise of control that uses gender roles and norms to decrease
a person’s power.
2. Intersectional factors increase or decrease a person’s vulnerability.
3. The greater the power an individual or institution holds, the easier it is for them to perpetrate
GBV.
STEP 3
Project SLIDE 17.
Direct participants to turn to Case Study 1: Rahima on page 21 of their Participant’s Manual (page 51 of
this Trainer’s Manual). Instruct them to take a few minutes to read Rahima’s story to themselves, after
which we will have a group discussion focused on these questions:
For Group Discussion

1) What elements of Rahima’s story demonstrate the common gender norms and expectations
in your communities?
2) Do you see examples of the men and women in Rahima’s story having different levels or
different types of power?
3) Do you think that gender norms and gender-specific power influences the FP choices in
Rahima’s story? Why or why not?
4) Do you see examples of GBV in Rahima’s story? Why or why not?
41
TRAINER NOTE
Be sure to highlight the following points if they are not raised during participants’ discussion:
Related to question 1
• Gender norms related to educational attainment value (e.g.: male education is more
important than female education)
• Expectations for early marriage for girls
• Pressure to conceive and bear children
• Rahima’s father is the decision maker regarding his children’s education and marriage. It
does not appear that Rahima’s mother has much of a say or was even consulted.
• Rahima appears to have some power, as she as advocated to delay her first pregnancy
successfully. She has strong power within herself to affirm that agency as a new bride.
• Rahima’s father has robust power over his children and family. He makes decisions, and
these decisions are followed.
• Rahima and Aklina were both forced into child marriages.
• From the information provided but is not possible to tell whether other forms of GBV are
present. Given Rahima’s mother’s strong desire for her daughters to complete higher
education, the ultimate outcome suggests there may be threats or actual violence within
her marriage. However, this may also be a manifestation of gender inequity and power
imbalances without any actual violence. It is important that, as we become more aware of
GBV, we also remember that challenges and inequity can exist without violence.
42
Session 1-B: Gender Relevance in FP Success and Failure
1 H.
Introduction and FP’s Influence on Broader Health (30 min.)
STEP 1
Present SLIDE 18. Sharing the following information with participants:
We began to look at the ways that gender and power interact with FP success or failure. Now,
we will explore that more deeply. But first a reminder on how broadly FP influences SRH, family
health, and social health.
STEP 2
Present SLIDE 19. Participants may turn to page 22 of their Participant’s Manual to follow along. Ask
participants to raise their hands to share their answer, including their reason for any given answer. More
questions have been provided than can typically be discussed in the planned time. Choose 5–6 questions
that feel most relevant—based on participants’ stated expectations (You can reserve any of the
questions you do not initially use to further expand upon these ideas, should participants need
additional time and reflection to understand how gender affects FP and RH).
Take 2–3 responses for each question. Allow for brief, respectful debate among participants.
TRAINER NOTE
Points to consider highlighting—based on participants’ responses—are noted in green text in the table
on the next page.
43
QUESTIONS TO ASK TO ACCESS HOW GENDER AFFECTS FP AND RH OUTCOMES
Question Answer
Are there gender constraints around who has the authority to access FP and RH services?
• Women may not have independent financial resources
• Women may have limited independent mobility to reach a FP clinic or may be expected to
have an escort
• Women may be expected to have a husband’s permission to access FP and RH services
Who in the couple typically makes FP decisions?

• This depends on perspective and varies widely between households. In some cases, it is
neither the husband nor the wife, but may be another household member, such as the
woman’s mother-in-law.
• It is important to be mindful that even if a woman is at an FP consultation alone, the
decisions she expresses may be stemming from fear of violence at home. This is coerced
decision making.
Do women need permission from husbands/in-laws to seek an FP method for themselves?

• Legally, no. However, this brings up the complex nature of this subject. Many women do
need permission in order to keep themselves safe from various forms of domestic or
intimate partner violence.
Are there gender norms that affect men’s or women’s perception of using FP?
• Consider norms related to proving fertility, the perception of contraception as a means to
hide infidelity, the idea that large families signal male virility, etc.
Are there gender norms that affect men’s or women’s use of FP and RH services?
• Gender norms play an even more varied role in behaviors and use of services than they do
in perception and attitudes. In addition to the norms that influence perception of FP
highlighted in the previous question, gender norms affect:
• Men and women’s likelihood of being available during FP clinic hours.
• An individual’s comfort and ability to move from their home to an FP point of service.
• An individual’s level of agency and autonomy to make decisions about for FP and RH.
Are there unequal decision-making abilities between men and women about whether and
when to seek FP and RH services?
• Potential questions to pose to participants:
• Is it common for women to feel they need their husband’s permission to seek FP
services? What about men feeling the need to seek their wife’s permission?
44
• Do most women need to justify and explain their time spent outside of the home?
Do men?
• Do you know women who worry about experiencing violence if men in their
household discover they are using FP? Do you know men who worry about
experiencing violence if they use FP?
Is there accessible, relevant, and accurate information about FP and RH tailored to young
men?
• Men, and young men in particular, often lack tailored, accessible information. FP/RH
providers have an important role to play in giving young men and all men relevant,
accurate information.
• Increasingly, global job aids and IEC materials tailored to young men are being developed.
You might consider speaking to your facility head to inquire about securing a Bangla
translation.
Do FP and RH service providers treat men and women equally?

• Potential questions to pose to participants:
• Do you or have you ever questioned a female client on whether she really wants a
permanent method? Have you hesitated to provide one? What about your male
clients?
• Have you have asked a female client if her husband knows she is at the clinic? Have
you ever asked a male client the same about his wife?
• Do you respond differently when a male adolescent requests condoms versus when
a female adolescent does the same?
Do FP and RH facility- and/or community-based providers facilitate male involvement?

• There are structural, systemic, and individual pathways to facilitate male involvement.
• Respective examples include ensuring FP providers have information education
communication (IEC) materials that are designed for men as well as women, ensuring
providers have job aids and visit flow guidance that includes invitations for couple-based
counseling, and using the skills we’ll be practicing in this training to be mindful of how
power dynamics may help or hinder male involvement.
45
FP’s Influence on Broader Health (10 min.)
STEP 1
Present SLIDES 20–23, which highlight the importance of FP to global goals and Bangladesh’s
longstanding commitment to FP.
“Investing in family planning is a development ‘best buy’ that can accelerate achievement across the 5
Sustainable Development Goal themes of People, Planet, Prosperity, Peace, and Partnership.”21
21 Ellen Starbird, Maureen Norton, and Rachel Marcus. “Investing in Family Planning: Key to Achieving the Sustainable Development Goals,” Global Health: Science
and Practice, 2016 Jun 20; 4(2): 191–210.
46
Bangladesh has achieved historic progress in expanding access to voluntary contraception for nearly half
a century. The percentage of married women of reproductive age who are using family planning
increased sevenfold in less than 50 years.
Increase in Contraceptive Use

The percentage of married women ages 15–49 who are using any method of contraception
When given options, many women in Bangladesh are choosing to have fewer children.
Decrease in Total Fertility Rate

The number of children that would be born to a woman if she were to live to the end of her childbearing
years and bear children in accordance with age-specific fertility rates of the specified year
47
REFERENCE: BANGLADESH’S FP PROGRESS

Bangladesh was the tenth most populous country in the world when it achieved independence in
1971. The government of Bangladesh set out to address what it saw as urgent, interconnected
threats to families and the young nation: rampant poverty, limited food and resources, devastating
rates of infant and child death, and mounting population pressures. Bangladesh took swift action
to enhance family planning education and services.
A cornerstone of Bangladesh’s strategy to bring contraceptive options to people’s doorsteps was
the deployment of a massive cadre of female frontline health workers (called “family welfare
assistants”) who provided contraceptive counseling and services to women where they live.22
Between 1976 and 1980, when it was uncommon for women in Bangladesh to work outside of the
home, the government recruited 22,500 women from local communities as family welfare
assistants. These frontline health workers became a symbol of empowerment in communities and
revolutionized family planning service delivery for hard-to-reach women and families.
For the next 50 years, public and private-sector stakeholders, policymakers, health care providers,
religious leaders, researchers, academics, international donors, media agencies, and organizations
teamed up to achieve family planning milestones. Bangladesh has leveraged the power of these
partnerships to transform its health systems, generate new evidence, and remove barriers that
keep women and girls from exercising their right to contraception and sexual and reproductive
health care.
Bangladesh’s achievements demonstrate what’s possible when generations of women gain the
health care, knowledge, and support they need to achieve their desires for smaller, healthier,
more educated, and more prosperous families. Bangladesh’s longstanding investment in family
planning has paid off.
But today, Bangladesh’s family planning agenda remains unfinished. Progress is stalling. The
percentage of women currently using modern contraceptives decreased from 54 percent in 2014
to 52 percent in 2017–18.23
22 Sidney Ruth Schuler, Syed M. Hashemi, and Ann Hendrix Jenkins. “Bangladesh’s Family Planning Success Story: A Gender Perspective.” International Family
Planning Perspectives, Volume 21, Number 4, December 1995.

23 BDHS 2017–2018.
48
Bangladesh’s Historic FP Progress24

• One of the oldest family planning programs in the world (launched 1953).
• In less than 50 years, percentage of married women of reproductive age who are using family
planning increased sevenfold.
• Today, contraceptive prevalence rate is 62 percent, and 52 percent of women are using modern
contraceptive methods.*
• GOB and DGFP has strong commitment and farsighted vision for FP program.
Bangladesh has been a leader in FP programming transforming women’s access to essential services.
Currently, the contraceptive prevalence rate among currently married women ages 15–49 is 62 percent,
and 52 percent of women are using modern contraceptive methods.25 More needs be done to ensure all
have access to a full range of contraceptive options.
Opportunities for Progress

• Address high rates of discontinuation: 37% of contraceptive users stop their selected method
within 12 months.
• Improve service quality and method mix: only 9% of currently married women are using a long-
acting or permanent method.
• Address unmet need among adolescents: 16% of adolescents ages 15–19 have an unmet need
for FP, compared to 5% among women at the end of their childbearing years (45–49)
• Improve services offered to women who were or are child brides: Nearly one-third (31%) of
women ages 20–49 report that they had married by age 15.
• Areas of Need: While the national CPR is 62 percent, there are sizable variations across age
geographies. For example, modern method use is highest in Rangpur (59%) and lowest in
Chattogram and Sylhet (both have a CPR of 45%).
Twelve percent of currently married women in Bangladesh have an unmet need for family planning
services.26 Too many women continue to struggle to exercise their right to access and use family
planning.
Inequality in household decision-making and finances affects women’s ability to independently access
and use FP. According to the Report on Violence Against Women (VAW) Survey 2015,27 women do not
24 BDHS 2017–2018.
25 BDHS 2017–2018.
26 BDHS 2017-2018.
27Bangladesh Bureau of Statistics, Statistics and Informatics Division, Ministry of Planning, Government of the People’s Republic of Bangladesh, Report on Violence
Against Women Survey 2015 (Dhaka, Bangladesh: 2016).
49
enjoy equal participation as men in household decision making. There is a correlation between women
who experience GBV and a decreased ability to negotiate using family planning methods, making them
more vulnerable to unintended pregnancies.28
Furthermore, as mobility was restricted during COVID-19 pandemic (social distancing and repeated
lockdown) for COVID-19 prevention, Bangladesh saw a spike in GBV,29 requiring recognition of the
impact that gender has on access to FP and other health services. Although the issues of FP access and
coverage were an area of concern before the pandemic, worsening conditions during the pandemic
period highlighted the importance of integrating GBV services into current and future pandemic
preparedness responses.
28 Pallitto, C. C., Campbell, J. C., & O’Campo, P. (2005). Is Intimate Partner Violence Associated with Unintended Pregnancy? A Review of the Literature. Trauma,
Violence & Abuse, 6(3), 217–235. http://www.jstor.org/stable/26636659.

29 UN Women, Measuring the Shadow Pandemic: Violence Against Women During Covid-19: Country Report: Bangladesh (New York: 2022).
50
Activity 3: Case Study, Discussion, and Presentation

Gendered Barriers and Drivers to Achieving National Goals (20 min.)
STEP 1
Project SLIDE 24.
Ask participants to turn to the Case Studies on PAGES 27–30 of their Participant’s Manual (pages 53–56
of this Trainer’s Manual).
Using a random assignment technique, such as counting off, divide participants into four small groups.
Assign each group one of the following case studies: Hena, Nazma, Rani, or Mr. Hossain. Instruct
participants to read their assigned case study as a group and discuss the three questions beneath the
case study. Explain that they will have approximately 10 min. in their small group before reporting back
in plenary.

• How does gender influence the power of the people in the story?
• Where do see gender and power helping achieve FP and SRH?
• Where do you see gender and power being a barrier to good health?
STEP 2
Present SLIDE 25.
Remind participants of the following:
While gender norms and power dynamics have significant impact on FP and RH, they are far
from the only determinants of service quality and outcomes.
OTHER RELEVANT BARRIERS

• Stock outs
• Lack of funding
• Lack of skilled service providers
• Distance to health service point
• Misinformation in communities
• Opportunity costs
• Service provider bias
• Legislative and legal barriers
• Cultural norms and traditions
51

Case Study 1: Rahima
Rahima (pseudonym) is a bright child. She is one of her parents’ four children (two boys and two
girls). Rahima’s mother always dreamed Rahima would be a doctor one day, so she made her all
children go to school for primary education. Unfortunately, when Rahima and her elder sister,
Aklima (pseudonym), passed to fifth and seventh class, her father suddenly told Rahima’s
mother that, day by day, the education of all their children has become too great a burden.
Although they can avail free education, the tutor and other expenses were becoming
unbearable for him, so he decided to stop the girls’ education. He would only continue with the
boy children—to finish their education at least to SSC level, so they can manage to find any
primary-level job. He also planned to get the elder daughter married off, so the family could get
a better husband (with less dowry-related demand); if they delay, the dowry will be high.
Rahima’s mother and the two daughter became very upset hearing this. Although Rahima’s
mother insisted that she could convince her husband to continue Rahima’s education up to class
eight, by the time Aklima got married and gave birth to one child, Rahima realized that her fate
is going to be the same within a few months.
One fine morning, Rahima woke up from a bad dream—that someone snatched her stethoscope
from her neck, stealing this precious belonging that she carried every day and cherished most in
her life. To her great dismay, the next morning, her soon-to-be husband gave a flower garland
for her neck. Her dream of becoming a doctor became tarnished. She had to start the same
cycle of life as her elder sister.
Now, it is almost two years later. Rahima is married, though she is not pregnant yet. Because of
her education, she managed to convince her husband and in-laws to continue with an FP
method. Still, her dream of having her stethoscope stolen haunts her every night!

5) What elements of Rahima’s story demonstrate the common gender norms and expectations
6) Do you see examples of the men and women in Rahima’s story having different levels or
7) Do you think that gender norms and gender-specific power influences the FP choices in
8) Do you see examples of GBV in Rahima’s story? Why or why not?
52
Case Study 2: Hena
Hena (pseudonym) got married at the age of 14 to Rahim (pseudonym), age 35, who lives in the
neighboring upazila. Rahim’s family is comparatively better off than Hena’s family, so they didn’t
ask for any dowry during the marriage. However, the in-laws started imposing pressure on Hena
to become pregnant soon after marriage, which was not resisted by Rahim. In just six months
after getting married, Hena became pregnant. Hena was very shy, so she didn’t feel comfortable
talking to her husband about taking any FP methods. Her first child, a daughter, was delivered at
home, assisted by her grandmother-in-law.
Then, within two years, Hena got pregnant again and delivered another girl child. Pressured by
her in-law to give birth to a boy child, Hena had to take the risk—to get pregnant a third time by
age 19. This time, she started suffering from various pregnancy-related complications.
Luckily, Hena was introduced to an FP field worker who is also a distant relative of Hena’s
husband. As a field worker, this woman is quite empowered and also very much valued in
society for her good work. So, she supported Hena all the way throughout the pregnancy and
convinced her in-laws to allow her to take her into the nearby community clinic for a regular
checkup. Due to high risk of complications, the CHCP referred Hena to the nearby upazila health
complex, where she delivered a healthy boy child. Hena’s in-laws and her husband became very
happy and started believing in health care checkup for Hena, so allowed her to send for regular
postpartum checkups. During these checkups, Hena learned more about FP methods and also
other important SRHR information, which helped her to maintain a healthy life for herself and
her children.

• Where do see gender and power helping achieve FP and SRH?
53
Case Study 3: Nazma
Nazma Begum (pseudonym) is an 18-year-old mother of two female children. Her husband is a
laborer. Nazma and her husband got married five years ago, when Nazma was 13.
At the time, Nazma’s husband demanded a chain of gold, but Nazma’s father failed to fulfill the
dowry, due to his poverty (Nazma’s father is a school teacher, and he has seven daughters and
one son). Nazma’s husband and mother-in-law tortured her for this. Moreover, they always
made her feel guilty for giving birth to two female children. They forced Nazma to conceive a
male child. As a result, she is now in her third pregnancy with heavy weakness. She is
experiencing acute anxiety at the thought of continuing this pregnancy or not.

• Where do you see gender and power helping achieve FP and SRH?
54
Case Study 4: Rani
Rani (pseudonym), age 25, worked in a house in Mohammadpur, Dhaka. Rani worked day and
night to provide for her husband and two children. The house owner and other members
treated her well since she had working there for two years. When she got pregnant with her
third child, her Madam from work supported her financially, so Rani could get proper treatment.
They recommended that Rani visit a health care facility for her antenatal care (ANC) checkup
and treatment and took her there to get registered.
Rani took a break from her work during pregnancy but got salary and other benefits from the
house owner every month. Then, one day after the ninth month, Rani disappeared with her
family. Her husband took her to Gaibandha where his family lives. They did not allow Rani to
come back to Dhaka for delivery. They did not consider Rani’s decision and opinion. When the
time came, one native Daye (TBA) made the delivery at home. During the process, Rani
experienced postpartum hemorrhage and died along with her newborn baby.

• Where do see gender and power helping achieve FP/SRH?
55
Case Study 5: Mr. Hossain
Mr. Hossain (pseudonym) is a well-known, well-respected, mid-aged member of his community

of Olipur, Hajigonj. He always inspires people with his speech in the light of Islam. He is also a
father of three daughters and one son. However, one day he brought he wife in for menstrual
regulation (MR), and the provider noticed this was her ninth MR in five years. The provider
congratulated the couple on their healthy family and asked if the couple was using
contraception. Mr. Hossain replied that he is against family planning, but he doesn’t want any
more children, so his wife must take MR.

• Where do see gender and power helping achieve good FP and SRH?
• Where do you see gender and power being a barrier to good health
56
Module 2: Foundations in GBV

• Session 2-A: Understanding and Conceptualizing GBV
• Session 2-B: GBV Risk Analysis in FP and SRHR
• Session 2-C: Male Engagement in GBV Prevention Awareness
• Session 2-D: Understanding GBV in FP and SRH for Adolescents and Youth
LEARNING OBJECTIVES
After completing this module, participants will be able to:
• Articulate the many different forms and manifestation of GBV.
• Understand how GBV is an intersectional issue that can affect anyone regardless of age,
marital status, or economic class.
• Communicate the health risks and impacts suffered by those living with GBV.
• Recognize and communicate GBV impacts across the life cycle.
• Identify verbal and non-verbal cues that an FP and SRH client is high risk for current GBV.
• Clarify concepts around male engagement in GBV prevention awareness.
• Articulate the risks and impacts of child, early, and forced marriage and unions (CEFMU) and
GBV among young people.
• Understand how national laws impact FP & RH service provision for CEMFU-involved clients.
METHODOLOGIES
• Presentation
• Case Study
• Discussion
• Reflection
MATERIALS NEEDED
• Case Studies 6–8
• Tool C: Vote with Your Feet Statements
• Participant Manual for each participant
ADVANCE PREPARATION
• Review Vote with Your Feet Statements
• Arrange the area, so that there is adequate space for participants to move from one side of
the room to the other and post flipchart paper on opposite ends of the room—the one on the
right saying “Agree” and the one on the left saying “Disagree”
57
MO DU L E 2: FO U NDA T IO N S O F GB V
Session 2-A: Understanding and Conceptualizing GBV
45 MIN.
Activity 1: Presentation and Discussion

GBV—Forms, Patterns, and Health Impacts (45 min.)
STEP 1
Present SLIDES 26–27 and identify the session’s learning objectives:
• Be able to articulate the many different forms and manifestation of GBV.
• Understand how GBV is an intersectional issue that can affect anyone regardless of age, marital
status, or economic class.
• Be able to communicate the health risks and impacts suffered by those living with GBV.
STEP 2
Project SLIDE 28. Share the following with participants:
Let’s look at the definition of gender-based violence again. Within that very broad definition,
there are many different forms and types. Particularly impacting FP/SRH is violence against
women and girls.
As FP providers, it is critical to be aware of GBV, its various forms, and its impact on clients’
health and wellbeing, including on FP and RH. GBV refers to any act that is perpetrated
against a person’s will and is based on gender norms and unequal power relationships. GBV
inflicts harm on women, girls, men, and boys. It encompasses:
• Threats of violence and coercion

• Physical or sexual assault
• Emotional or psychological harm
• Denial of resources or access to services

• Denial of legal self-autonomy
58
GBV takes many forms. Some forms of GBV are outwardly apparent, such as physical
violence, and some are subtler or hidden, such as verbal abuse or reproductive coercion. All
forms of GBV are harmful and have a negative impact on an individual’s health and
wellbeing.
GBV can impact anyone, regardless of class, religion, caste, or ethnicity; however, GBV
impacts women and girls far most frequently.
Violence and/or fear of violence can influence a woman or girl’s access to FP, as well as her
choice of method and ability to use it.
Acts of GBV are perpetrated to gain power and control. In a couple, this can include power
over reproduction and the use of FP.
Violence Against Women and Girls (VAWG) refers to any act that is based on gender norms or
unequal power dynamics that results in, or is likely to result in, physical, sexual, or mental
harm to women, including threats, coercion, or arbitrary deprivation of liberty,
whether occurring in public or in private life. VAWG can include:
• Intimate partner violence (IPV)
• Sexual assault and rape
• Female genital cutting
• Reproductive coercion
• Forced marriage
• Trafficking
• Denial of education, financial, and legal services
STEP 3
Ask participants to reflect and look back on the vignettes discussed in their small groups during the last
session. Ask: “Do you think any of the case studies we have looked at include one or more of these forms
of violence? Which ones? Why?”
Take 10 minutes to hear responses.
TRAINER NOTE
For reference, here are the forms of violence by case study:
• Hena’s story – reproductive coercion; CEFMU
• Nazma’s story – CEFMU; emotional abuse; reproductive coercion
• Rani’s story – denial of services; denial of legal autonomy
• Mr. Hossain’s story – reproductive coercion
59
STEP 4
Present SLIDE 29.
FORMS AND MANIFESTATIONS OF GBV
Physical
• Hitting, beating, burning, and cutting
• Trafficking
• Acid attacks and honor killings
Social
• Discrimination and/or denial of opportunities
• Denial of education
• Denial of inheritance and/or property rights
Emotional/Psychological
• Abuse and humiliation
• Confinement/isolation
• Intimidation/threats
• Blame for uncontrollable outcomes
Sexual
• Forced Marriage
• Sexual Exploitation/Forced Prostitution
• Rape
• Harassment
• Female Genital Cutting
60
Present SLIDE 30.

REPRODUCTIVE COERCION
Reproductive coercion is a complex form of VAWG that can be perpetrated using physical,
sexual, psychological and/or social violence, most commonly through a combination of these
forms. Examples include:
• Repeated shaming and blaming of a woman until she gives birth to a son.
• Forcing a women or girl to undergo MR to avoid pregnancy.
• Throwing away contraceptive pills or condoms.
• Using a pin to put holes in condoms.
• Denying a women freedom of movement and/or access to resources to access FP
Emphasize the following to participants:

Reproductive coercion can be very explicit and direct, such as contraceptive sabotage or directly
refusing to allow a woman to go to a FP appointment, refusing to take her for MR, forcing a
woman to have unprotected sex when she is fertile, etc.
It can also be more indirect, using forms of social and psychological/physical violence, such as
patterns of humiliation and abuse against women who do not demonstrate fertility early and
frequently.
61
Present SLIDE 31.

BANGLADESH’S NATIONAL PREVALENCE OF GBV
VAW in Bangladesh Facts

2017 study | total 1,143 victims30
• 63.78 percent belong to age group of 16–30 years, and 19.16 percent belonged to
the age group of 1–15 years.
• Regarding the marital status of victims, 71.91 percent were married, and 25.63
percent were unmarried.
• Most of the victims (60.37%) were “housewives” followed by “others” (11.46%),
“students” (11.11%) and “maid servants” (10.85%).
• Most of the perpetrators were “husbands” (64.65%) followed by the “known
person” (14.00%), neighbors (13.30%), “lovers” (3.15%), “house master and
mistress” (2.62%), and “in-laws and others” (2.27%).
Report on VAW Survey 201531

• 72.6 percent of ever-married women experienced violence by their husband at least
once in their lifetime.
• 27.8 percent of women reported lifetime physical violence by someone other than
their husband.
• The lifetime rates of emotional and sexual violence are 28.7 percent and 27.2
percent, respectively.
30 Nashid Tabassum Khan, et. al., “Violence against Women in Bangladesh.” Delta Med Col J. Jan 2017; 5 (1):25 – 29.
31 Bangladesh Bureau of Statistics, Statistics and Informatics Division, Ministry of Planning. Report on Violence Against Women Survey (2015).
62
Present SLIDE 32.

UNITED NATIONS DECLARATION ON THE ELIMINATION OF VIOLENCE AGAINST WOMEN
Declaration adopted December 1993:
Article 1
For the purposes of this Declaration, the term "violence against women" means any act
of gender-based violence that results in, or is likely to result in, physical, sexual, or
psychological harm or suffering to women, including threats of such acts, coercion, or
arbitrary deprivation of liberty, whether occurring in public or in private life.
Article 4
States should condemn violence against women and should not invoke any custom,
tradition or religious consideration to avoid their obligations with respect to its
elimination. States should pursue by all appropriate means and without delay a policy of
eliminating violence against women.
REFERENCE: CEDAW RECOMMENDATIONS

CONVENTION ON THE ELIMINATION OF ALL FORMS OF DISCRIMINATION AGAINST
WOMEN (CEDAW)
General Recommendation No. 19, January 1992:
Article 1
The definition of discrimination [against women] includes gender-based violence, that is,
violence that is directed against a woman because she is a woman or that affects women
disproportionately. It includes acts that inflict physical, mental, or sexual harm or suffering,
threats of such acts, coercion, and other deprivations of liberty.
From Article 16 (and Article 5)

Lack of economic independence forces many women to stay in violent relationships.
For the full General Recommendation, visit ohchr.org
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Present SLIDE 33.

BANGLADESH NATIONAL LAWS AND COMMITMENT
• In 2014, Bangladesh made a commitment to ending child marriage in the country by
2041.
• Multiple facets of the penal code provide for severe punishment in cases of specific
forms of GBV, including acid attacks, femicide to gain new or increased dowry, and
denial of child custody.
• Signatory to international conventions include ICPD and the UN Special Declaration
against Violence against Women.
• Marital rape is exempt from legal prosecution, except cases where the wife is below
age 13.
Share the following with participants:

It is important to note that the legal framework regarding marital rape in Bangladesh is complex
and contradictory. All laws confirm that intimate relations between spouses when the wife is
under the age of 13 is rape.
It is also clear that martial rape is not criminalized in Bangladesh when the wife is of legal age to
be married (18). However, for married adolescents ages 13–18, it is unclear what level of legal
protection they may have. As health providers, what you need to know is this:
• All women, regardless of age or marital status, are entitled to access emergency
contraception services.
• All girls under the age of 18 are legally entitled to refuse marriage.
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Session 2-B: GBV Risk Analysis in FP and SRHR
45 MIN.
Activity 1: Presentation, Discussion

Introduction and Learning Objectives (15 min.)
STEP 1
Present SLIDE 34, highlighting the following learning objectives:

• Identify verbal and non-verbal cues that an FP and SRH client is high risk for current
GBV.
STEP 2
Project SLIDE 35 and ask participants:
“Can you name a gender or GBV-based FP/SRH service access barrier at each stage of a client’s
lifecycle?”
Take 5–10 minutes for discussion, then advance to the next slide.
Present SLIDE 36.
65
REFERENCE: GBV ISSUES ACROSS THE LIFE CYCLE
ELDER
ADULT
YOUNG ADULT
TEENAGER
CHILD
INFANT
INFANT: Female feticide, sex-selected abortion, infanticide, mal/undernourishment by

withholding nutritious food, medical care withheld.
CHILD: Little or no schooling, child labor, child prostitution, physical abuse, neglect, sexual
abuse, molestation, abusive ’teasing’ by sibling.
TEENAGER: Coerced sexual initiation, rape, forced marriage to parent's choice, much older
man, teen's rapist; ignorance about sex, anatomy, and sexual health; control over sexuality and
sexual orientation; trafficking; forced into prostitution; cyber stalking by boyfriend or unknown
predators; date violence; harassment; public lewdness; and sexual harassment by extended
family, teachers, coaches, peers.
YOUNG ADULT: Date violence; drug-facilitated rape; rape, including wartime rape; denial of
choice of marriage partner and/or sexual orientation; dowry-related deaths; intimate partner
violence; sexual harassment at work, college.
ADULT: Domestic violence, same-sex domestic violence, violence by father-, mother-, sisters-,
brothers-in-law and natal family members; sexual abuse, including marital rape, forced to
watch and imitate pornographic acts, extreme sexual neglect or coldness; economic abuse,
including ruined credit or gambling; isolation, permanent or temporary abandonment; battery
during pregnancy; coerced into criminal activity; extreme exploitation of household labor;
sexual harassment by employers, other employees, fathers-, brothers-in-laws, clergy,
therapists, doctors; victim-blaming and rejection by community; forced into unprotected sex;
infected with STIs, HIV; denying mothers access to custody of children, abduction/kidnapping;
intimate homicide, femicide, and honor killings; withholding adequate food, clothing, daily
necessities; stalking, cyber stalking.
ELDER: Physical abuse by adult children, caretakers; spousal abuse; exploitation of household
labor; childcare; withholding health care, medications, daily necessities; demeaning
widowhood; and coerced suicide pacts or mercy killings.
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GBV IMPACTS ACROSS THE LIFE CYCLE

Mental health impacts: e.g., depression, anxiety, flashbacks, substance abuse, and
suicidal ideation.
SRH impacts: e.g., unintended pregnancy, HIV, STIs, cervical cancer, miscarriage, pre-
term labor, and stillbirth.
Physical impacts: e.g., broken bones, contusions, internal bleeding, malnourishment,
and death.
Social impacts: e.g., school dropout, unemployment, isolation, limited contribution to
civil society, and poverty.
STEP 3
Present SLIDE 39.
WHAT CAN GBV LOOK LIKE IN FP AND SRH?
• A woman in the postpartum ward who waits until her mother-in-law has gone outside to ask
about PPFP
• An FP client who frequently has bruises on her face or wrists when she comes for refill
appointments
• An adolescent girl who doesn’t speak for herself when brought by a parent for MR
• A FP client who asks if there are options that her husband cannot throw away
• An IUD client who returns with her partner soon after insertion asking for removal
Remember: Living with GBV is different for everyone! Never force a disclosure. Never
assume someone is immune to GBV.
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Our Lived Experience (30 min.)
STEP 1
Introduce the reflection activity to participants. Remind everyone of confidentiality and other Do No
Harm principles, as well as group norms related to self and collective care. Let participants know that
there will be a lunch break following this activity and all facilitators are available during the break if
anyone would like to speak further and/or privately about challenges they are facing.
STEP 2
Invite participants to share their experience as providers. Encourage participants to share—by show of
hands—experiences they have had in their course of work as an FP provider with clients living with GBV,
suspecting but not being able to confirm GBV, or providing care and/or referrals to a client who has
experienced GBV. Remind participants not to share identifying information about clients and to focus on
sharing personal experiences, not the experiences of colleagues. Ask participants to keep the stories
brief (2-4 minutes) so that anyone who wishes to share has time. No one is obligated to share.
STEP 3
Wrap up and emphasize the following:
Universal sharing of GBV referral options is a best practice. Many women living with GBV show
no warning signs and will not choose to disclose.
On Day 2, you will have further opportunity to practice encouraging disclosure in these types of
client encounters through role play and vignettes.
LUNCH BREAK before continuing to next session.
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Session 2-C: Male Engagement in GBV Prevention Awareness
30 MIN.
Introduction, Learning Objectives, and Foundation (20 min.)
STEP 1
Present SLIDE 40, highlighting the session’s learning objectives:
• Clarify concepts around male engagement in GBV prevention awareness, including pros and
cons, challenges and successes, and evidence.
Present SLIDE 41–46, further illustrating why male engagement in GBV prevention is important.
LOOKING AT MEN FROM A DIFFERENT PERSPECTIVE

• Men have the status and power to help change social and behavioral norms to end the
abuse of women
• Men play many roles in society that place them in positions to discourage the abuse of
women—as fathers, judges, police officers, community leaders, husbands, sex partners,
health care providers, policy makers, and community advocates/positive influencers.
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POTENTIAL ROLE OF MALE ENGAGEMENT TO IMPROVE WOMEN’S FP AND SRHR STATUS
“Engaging men and boys as users, supportive

partners, and agents of change improves health
outcomes. More specifically, engaging men in
FP/RH programs has been successful in
decreasing unintended pregnancies, improving
maternal health, reducing sexually transmitted
infections (STIs) and HIV/AIDS, and better
meeting the needs of youth.”32
Engaging men in FP can be beneficial for
contraceptive access, use, and continuation.
When done correctly, male engagement has
been shown to promote positive couple’s
communication and cooperative decision
making. When men are engaged in
constructive ways—as FP users, supportive
partners, and agents of change—it can
improve both health and gender outcomes.
Evidence has shown that engaging men in FP
and RH programs has been successful in
decreasing unintended pregnancies,
improving maternal health, and reducing STIs,
including HIV.
32 Breakthrough ACTION. Advancing male engagement in family planning and reproductive health: An advocacy tool. Johns Hopkins Center for Communication
Programs (Baltimore: 2018).
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BENEFITS OF MALE ENGAGEMENT IN SRHR

• Male engagement can reduce the spread of HIV and AIDS and sexually transmitted infections.
• Male engagement can lessen the ill effects of men’s risky sexual behavior on the health of
women and children.
• Men and husband, in most cases, approve of FP.
• Men make decisions that affect women's and men’s health.
• Men can gain awareness that gender affects sexual behavior, reproductive decision-making, and
reproductive health.
• Male engagement can help meet demands from women for more involvement.
• It provides opportunities for men to promote better RH, and they can play a role.
• As individuals, men benefit from intentional family building and chosen timing and spacing of
children.
• As family members, men honor their responsibilities to care for their wives and children by only
having children and when safe and healthy for the family.
• As community leaders and policymakers, men support strong, thriving communities by
encouraging intentional FP and health timing and spacing of pregnancies.
RISKS OF MALE ENGAGEMENT

• Already imbalanced power over fertility and health decisions.
• More attention to men in limited resource setting (human resource, logistics, and client time)
can result in unintentional pulling of resources away from women- and girl-centered outreach
and services.
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ENGAGING MEN IN FP IS A PERSONAL ISSUE33,34

• Check your assumptions.
• Understand power dynamics.
• Own the reality: for better or for worse, men are involved.
• Men are underserved, yet many want to be engaged fathers and supportive partners.
• Men are family planning clients and users in their own right.
• Don’t count men out from health services.
• Providers need to think about social norms, too.
• Address men even when they are not present.
• Reach men where they are, through their networks.
• Men can and do participate positively in family planning.
• When done right, involving men in family planning yields significant benefits for women and
families.
In Safe Motherhood and SRHR, men play many key roles, their decisions and actions make a difference
during:
• Pregnancy
• Delivery
• Postpartum period
33 Faramand TH, Treleaven E. 2012. Integrating Gender in Improvement Activities. Implementation Guide. Published by the USAID Health Care Improvement Project.
Bethesda, MD: University Research Co., LLC (URC).

34 MEASURE Evaluation, Male Engagement in Family Planning Indicator Brief, 2018.
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Activity 2: Discussion and Presentation

Questions on Male Engagement (10 min.)
STEP 1
Project SLIDE 47. Tell participants that it is time to for a pop quiz! Ask participants to call out answers as
you read each statement in turn.
STEP 2
If there is not general consensus on the answer, ask 1–2 participants to share why they gave the answer
they did. Clarify and correct any misinformation. The correct answer is shown in green text below.
MEN: FULL PARTNERS AND ADVOCATES FOR GOOD REPRODUCTIVE HEALTH

• Reaching men is a winning strategy. Yes / No
• To encourage sexual responsibility. Yes / No
• To foster men’s support of their partners’ contraceptive choices. Yes / No
• To address the reproductive health care of couples. Yes / No
• Men play dominant roles in decisions. Yes / No
• Men are more interested in family planning than assumed. Yes / No
• Need communication and services directed specifically to them. Yes / No
• Understanding-and influencing-the balance of power is important. Yes / No
• Couples who talk to each other reach better, healthier decisions. Yes / No
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Session 2-D: Understanding GBV in FP and SRH for Adolescents and

Youth
1 H. 10 MIN.
Introduction and Learning Objectives (20 min.)
STEP 1
Present SLIDE 48, highlighting the learning objectives for this session:
• Be able to articulate the risks and impacts of child, early, and forced marriage and unions
(CEFMU) and GBV among young people.
• Understand how national laws impact FP and RH service provision for CEMFU-involved clients.
REFERENCE: BACKGROUND
The term adolescence is derived from the Latin word “adolescere,” meaning to grow, to mature.
Adolescence is considered a period of transition from childhood to adulthood, characterized by rapid
physical growth. Adolescents are no longer children, but not yet adults.
The term “young people” includes girls and boys aged between 10 and 24 years, spanning the periods
defined as adolescence (10 to 19 years) and youth (15 to 24 years). Young people make up a significant
proportion of countries’ populations and comprise 16 percent of the global population.35
35 “Youth,” United Nations, accessed Feb 3, 2023, www.un.org/en/global-issues/youth
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STEP 2
Present SLIDE 49.
ADOLESCENTS AND YOUTH: BASIC CONCEPTS
Age Groups
• Adolescents: 10–19 years
• Youth: 15–24 years
• Young People: 10–24 years
Child, Early, and Forced Marriage and Unions (CEFMU)

Child and early marriage are any marriage in which one of the parties involved is below the age of 18.
Forced marriage and unions refer to any union in which one party did not consent—regardless of their
age. This term includes both formal, legal marriages, and as well informal union and cohabitation.
Present SLIDE 50.
Essential Elements of Comprehensive SRH Services for Young People36

• Provision of a full range of contraceptive information and supplies, including emergency
contraceptives.
• Counseling and information services on FP, pregnancy, and the prevention and treatment of
STIs, HIV and AIDS, and reproductive tract infections (RTIs).
• Basic equipment for provision of reproductive health services (e.g., FP, ANC, and laboratory
testing for STIs/RTIs).
• Services that cater for interrelated issues, such as mental health, nutrition, sexual abuse, and
GBV.
• Capacity to accommodate the needs of young people with special needs.
• A referral system.
The issues that affect young people’s SRH status can be complex and often interrelated.
36 WHO. Core competencies in adolescent health and development for primary care providers: including a tool to assess the adolescent health and development
component in pre-service education of health-care providers (Geneva: 2015).
75
REFERENCE: INTERNATIONAL CONFERENCE ON POPULATION AND DEVELOPMENT (ICPD)
The Program of Action of the International Conference on Population and Development (ICPD)
held in Cairo in 1994 and the Platform for Action of the Fourth World Conference on Women
(FWCW) held in Beijing in 1995 drew the attention of policymakers to the needs and rights of the
world’s adolescents.
Declarations urged that governments, nongovernmental organizations (NGOs), and the private
sector to prioritize programs, such as education, income-generating opportunities, vocational
training, and health services for adolescents, including services related to SRH. At ICPD,
government representatives agreed that to the following:
From ICPD Program of Action paragraph 7.3:

“Full attention should be given to the promotion of mutually respectful and equitable gender
relations and particularly to meeting the educational and service needs of adolescents to enable
them to deal in a positive and responsible way with their sexuality.”
Present SLIDE 51.
CONCEPTUALITY OF CHILD MARRIAGE

According to BDHS 2017–18, 71% of women ages 20–49 were married by age 18, and nearly one-third
(31%) of women 20–49 reported that they had married by age 15.
The current law in Bangladesh that addresses child marriage is the Child Marriage Restraint Act, 2017
(CMRA), which repealed the earlier British law of 1929. The Act sets the minimum age of marriage for a
male as 21 years and for a female as 18 years. This refers to both formal marriages and informal unions
in which children under the age referred with a partner as if married.
To address Bangladesh’s child marriage situation, the Prime Minister of Bangladesh made the following
commitments in 2014:
• Create a National Plan of Action by the end of 2014 (prepared in 2018).
• Revise the Child Marriage Restraint Act 1929 (revised in 2017).
• End the marriage of under 15-year-olds and reduce, by one third, child marriage under 18 years
by 2021.
• Eradicate child marriage from the country by 2041.
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NATIONAL TRENDS RELATED TO ADOLESCENT AND YOUTH SRH
Trends (%) of Child Marriage in Bangladesh, 1993–2017 (Source: BDHS)
Teenage Childbearing in Bangladesh (Source: BDHS)
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DRIVERS OF ADOLESCENT CHILDBEARING

• Social stigma and poverty.
• After giving birth, the status of girls’ and boys’ (wife and husband) may improve.
• Lack of girls’ individual identity/empowerment/agency.
• Barriers to contraceptive access and use among adolescent girls (unmet needs).
• Misconceptions around contraception.
• Familial and social pressure, and insecurity.
• Presumptions of infidelity and/or extra marital relationship.
REFERENCE: EXISTING LAWS TO ADVANCE AYRH AND RIGHTS
• The Dowry Prohibition Act of 1980 made the taking and giving of dowry an offense
punishable by fine and imprisonment.
• The Cruelty of Women Act (Deterrent Punishment Act of 1983) provides punishment by
death or life imprisonment for the kidnapping or abduction of women for unlawful purposes,
trafficking women, or causing death or attempting to cause death or grievous injuries to
wives for dowry.
• The Child Marriage Restraint Act ruled that, for marriage, the age of females should be
minimum 18 years and for male’s minimum 21 years (2017 6 No. Act).
• The Muslim Family Ordinance, 1961 (Amended in 1985) regulates certain aspects of divorce,
polygamy, and inheritance.
• The Penal Code (Second Amendment Ordinance) provides capital punishment for causing
grievous injuries or acid throwing.
• The Family Court Ordinance 1985 deals with causes of marriage and divorce, and the
maintenance, guardianship, and custody of children.
• The Correctional Home for Juvenile Offenders (Ordinance 1974) provides rehabilitation
programs for adolescent offenders under the supervision of magistrate.
• The Penal Code 1860 (Sections 312–314) permits abortions only for saving the life of
expectant mothers.
• The Anti-terrorism Ordinance of 1992 provides punishment for all types of terrorism
including teasing through making mockery of women or abducting children and women.
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Activity 2: Discussion
SRHR Service Needs of Adolescents and Youth (20 min.)
STEP 1
Project SLIDE 54. Ask participants to turn to page 45 of their Participant’s Manual. Tell participants they
can make notes in their manual through the discussion and keep the page as a reminder/reference after
the training.
STEP 2
For each classification of health need, ask for volunteers to share how common a need they think it is
among adolescents and youth and why. Request 1–3 comments for each type of service need. Check
marks in green in the table below indicate the actual prevalence of these needs at a national level in
Bangladesh.
Let’s make a list of the SRHR service needs of adolescents and youth
Type of Service GBV as Driver —
Most Common Sometimes Rare Need
Needs Y/N
Malnutrition ü
General health
problems (e.g.: viral
infection, bacterial
ü Y
illness, asthma, UTI)
Menstrual problems ü Y
Mental health issues
(e.g.: depression,
anorexia, sexual
ü Y
identity questions)
Contraception ü Y
Emergency
contraception and ü Y
menstrual regulation
Sexually transmitted
infection
ü Y
Addictive behaviors ü Y
Physical trauma (e.g.:
broken bones, ü Y
contusions, lacerations)
Sexual abuse and

assault response
ü Y
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Activity 3: Case Studies

GBV and FP Experiences of Adolescents and Youth (30 min.)
STEP 1
Project SLIDE 55.
Ask participants to turn to the Case Studies on pages 46–48 of their Participant’s Manual (pages 83–85
of this Trainer’s Manual).
Using a random assignment technique, such as counting off, divide participants into three small groups.
Assign each group one of the following case studies: Meena, Parvin, and Khadija. Instruct participants to
read their assigned case study as a group and discuss the prompts/questions:
In your group, prepare to present the following:

• Key facts of the vignette
• How was the case was first noticed in the FP/SRH clinic?
• What are your gender- and GBV-relevant observations?
• What are the solution points you considered—to handle the case?
Explain that they will have approximately 10 min. in their small group before presenting their feedback
in the plenary. Allow 15 min. group work and 15 min. for plenary presentation/discussion.
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Session 2-E: Day 1 Wrap Up
40 MIN.
Vote with Your Feet (30 min.)
STEP 1
Place the words “Agree” and “Disagree” at opposite ends of a room (or shared whiteboard if conducting
the exercise in a virtual environment).
Project SLIDE 56.
STEP 2
Ask the group to stand in the center of the room. Explain that you are going to read a statement aloud
(Tool C: Vote with Your Feet Statements on page 83 of this Trainer’s Manual). Tell the participants to
vote with their feet by moving to stand under the “Agree” sign or the “Disagree” sign.
Participants may stand anywhere—from an edge next to one of the words to the exact middle of the
room. Proximity to “Agree” or “Disagree” should align to the strength their belief. Some participants
may be conflicted and choose to stand in the middle of the room.
STEP 3
Read the first statement twice, making sure everyone heard it. Ask participants to move themselves to
where they personally fall on the spectrum.
STEP 4
After everyone chooses whether they agree or not, ask 2–3 participants from each side to explain why
they voted the way they did. Facilitate a brief discussion on their reasons.
STEP 5
Read more statements, following the same process, and ensuring enough time for discussion. Based on
time available and amount of discussion, you are likely to get through 6–8 statements. A greater number
of statements are provided here, so you may choose which statements are most relevant based on how
the day has unfolded. Prioritize allowing for reflective discussion even if it means you are not able to
read out all the statements.
STEP 6
Debrief the activity by explaining the following:
• There is no right answer.
• Power dynamics, values, and beliefs are complicated.
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Takeaways and Closing Questions (10 min.)
STEP 1
Present SLIDE 57, highlighting the following KEY TAKEAWAYS from the first day of training:
• Gender is socially constructed and gives everyone habits, values, biases, and assumptions.
• GBV affects 2–3 women in Bangladesh and has significant impacts on FP and SRH outcomes.
• People from all walks of life and of all ages experience GBV.
• Reproductive coercion is GBV.
• Addressing GBV is something men and women can and should tackle together.
STEP 2
Give participants a preview of Day 2, emphasizing the following:
Now that you have a better understanding of GBV, how it impacts FP and SRH services and
outcomes, and the needs many of your clients, you will have a chance to learn and practice skills
for identifying cases, making referrals, and documenting.
STEP 3
Project SLIDE 58.
Ask if there are any questions before ending the training for the day.
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Case Study 6: Meena
Meena (pseudonym) was 16 years old when her parents decided to get her married. Her groom
was a 22-year-old CNG driver in Ukhiya, Cox’s Bazar. Meena’s wedding date was determined
according to the last day of her period. Meena wanted to complete her HSC, so she didn’t want
to be a mother so soon. She asked for advice from her close aunts and relatives. They advised
her to take contraceptive pills before the wedding night but did not give her information about
what these pills were or how they worked. When she shared the matter with her husband, he
bought a random pill for her without a prescription. Meena got pregnant soon after marriage
and faced painful side effects from the pills she was taking. She had a complicated pregnancy
and faced early labor. After her delivery, she was traumatized to have a second child in the
future. Meena wanted to pursue her study and wait to have another child until completing her
schooling. Her husband got angry after hearing about her taking a FP method and abused her
badly. Her in-laws were also negative; they believe her duty is as a mother now.

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Case Study 7: Parvin
Parvin (pseudonym) was a bright student studying in class 7 at Naf High School. Due to the
family’s vulnerable financial situation, she got married early. She wanted to study after marriage
and complete her school. But her mother-in-law insisted she become a mother first and started
torturing Parvin every day. Her husband and family members were against Parvin.
Parvin went to her school teacher who used to work at an FP service center part-time. After
hearing Parvin’s situation, her teacher reached out to her family and husband. The teacher
made them understand that Parvin is only 13 years old, and she might not be able to survive if
she gets pregnant. The teacher explained that if Parvin uses a method now, she will still be able
to become pregnant in the future. But for now, her body is not ready for her to be a mother.
After this counseling, Parvin’s family agreed to delay starting the next generation until Parvin is
18 and followed the counselor’s referral to go to a clinic and get an FP method for Parvin to take
for the next five years. The FP provider also gave information on other risks from child marriage
and encouraged delay in sharing a marriage bed and that the family should help Parvin complete
her studies.

• How was the case first noticed in the FP/SRH clinic?
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Case Study 8: Khadija
Khadija (pseudonym) got married at the age of 16. Now, at 20, she is a mother of two children.
When the FP service providers reached Khadija’s village, Khadija got to know about FP methods
and received the required consultation. When Khadija expressed her wish not to have a child for
the next few years, the provider suggested taking a long-acting reversible contraceptive method
(IUD/Implant) to prevent pregnancy.
Khadija’s husband supported her decision, but her mother-in-law wanted more grandchildren.
Khadija and her husband then took her mother-in-law to FP center for consulting. There, the
counselors described to her how a back-to-back pregnancy harms a women’s body, and that a
women’s body needs time to heal. Khadija’s mother-in-law started to listen to the fact and, once
she understood, Khadija took a long-term method and lives peacefully.

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Tool C: Vote with Your Feet

Trainer’s discussion facilitation points are included below each statement in green.
TRAINER NOTE
This values clarification exercise can be very personal and uncomfortable for some participants. To
introduce the exercise and to diffuse tension, here are some neutral, non-GBV-related statements
to use as needed:
• I would rather ride a bike a mile than walk a mile.
• I love to cook.
• I am a good dancer.
INTRO STATEMENTS
1. Sex and gender are the same thing. They can be used interchangeably.
Sex and gender are distinct terms and should not be used interchangeably. Sex is determined by biology and
reflects the genetic, anatomical, and physiologic make up of an individual. A person can be male, female, or
intersex. Gender is defined and created by social norms and applied roles and values. Any person of a
nondominant gender (in almost all geographies, this will mean women or non-binary genders) is at greater risk of
gender-based violence.
2. In patriarchal societies, women’s gender norms and roles are harmful.

While in many patriarchal societies, women’s gender norms and roles can be harmful, such as when they create
inequity or limit access to education or health care, there are always both positive and harmful norms for every
gender identify. For example, the gender norms for women and girls that encourage social networks, sharing of
problems and emotions, and validate sadness and grief are healthy norms.
3. I am comfortable talking about gender-based violence.

Gender-based violence can be a very challenging subject to discuss, even for individuals who work on related
topics or provide related services on a regular basis. Any given day or week may be particularly difficult based on
personal history, memories, events, and family circumstance. IT IS ALWAYS OKAY TO TAKE A BREAK, DECLINE TO
SPEAK, EXCUSE YOURSELF, AND ASK FOR SUPPORT.
GBV STATEMENTS
4. As a health care worker, how I care for a woman who has suffered violence from a partner or is
being pressured into a specific reproductive decision will not make much difference.
Women subjected to violence often do not disclose their experience of violence to anyone because of fear of being
blamed or stigmatized or that no one will believe them. As a health care provider, even if a woman does not
disclose violence to you, studies show that such women are more likely to seek health care for a range of related
conditions. Hence, you are likely to encounter survivors of violence. Women also indicate that an empathic
response from a health-care provider can gain their trust for disclosing their experience. Therefore, an empathetic,
86
validating, and nonjudgmental response to a survivor is very important to the survivor and to putting her on a path
to healing.
5. Violence against women is a private matter and should not be discussed publicly.
Violence against women is a public health issue with grave effects on the health of women and families. There are
economic impacts as a result of the need to treat and respond to women’s health impacts, as well as the negative
impact on survivors’ economic productivity. There are also compounding effects on children/witnesses of violence
who may become violent themselves, drop out of school, or otherwise be unable to lead productive lives as a
result of the violence to which they were exposed. At the same time, individual experiences of violence are deeply
private, and confidentiality can be critical to the ongoing survival of a person living with GBV.
6. A man is entitled to have sex with his wife whenever he wants.

Every woman has the right to bodily integrity and the right to refuse sex. In many settings, however, gender norms
socialize women and men into believing that once you are married, the man is entitled to have sex with his wife
whenever he wants. In fact, in many countries, forced sex with your spouse is not considered to be rape. However,
women always have the right to control their own bodies and sexuality, and this means that they can say “no” to
sex with their husbands.
7. Women are just as violent as men in relationships.

The few population-based studies that have examined women’s perpetration of violence have found that the level
of violence experienced by men at the hands of their female partners is much lower than violence experienced by
women at the hands of their male partners. The violence perpetrated by women is less likely to result in physical
injuries, and often the violence is in response to violence perpetrated by the men. Violence by men against women
is also more likely to include sexual violence.
8. Most women are abused by strangers. Women are safer when they are at home.
Studies show that, in most settings, most perpetrators of sexual abuse are known to the survivors. Moreover,
intimate partner violence—that is, physical and/or sexual violence—is the most common form of violence
experienced by women. Therefore, unfortunately for many women, home is not necessarily a safe space.
9. Women who work outside the home in conservative areas are provoking sexual harassment or
assault.
There is never any excuse or justification for rape or any type of violence. Women who are abused should never be
blamed or told that it is their fault.
10. If a woman stays with a violent partner, it is her fault.

There are many reasons why a woman might stay with a violent partner. It is not our place to judge these women.
In fact, leaving a violent relationship can result in increased risk of violence from a controlling, violent partner.
Other reasons, such as economic dependence and social pressures not to break up the family, can prevent a
woman from leaving her violent partner.
11. A sex worker cannot be raped.

The fact that a person sells sex for a living does not mean that she/he is always ready and willing to have sex. Rape
is the act of forcing someone to have sex without their consent. Sex workers are often forced to have sex because
of the stigma that they are always available for sex. Even clients and potential clients can force sex workers to have
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sex. If someone has sex with you once, even when you paid for it, she/he does not necessarily have the right to
have sex with you again without your consent.
12. Men who have sex with men do not experience gender-based violence.
Gender-based violence is defined as “Any act, omission, or conduct that is perpetuated against a person’s will and
that is based on socially ascribed differences (gender) between males and females.” Men who have sex with men
defy the socially ascribed roles for males and females and, as a result, may experience abuse and violence. This is
considered a form of gender-based violence, although it is more precisely described as violence on the basis of
sexual orientation.
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Module 3: GBV-Responsive FP and SRH

Service Provision
• Session 3-A: GBV-Responsive Counseling in FP and SRHR
• Session 3-B: Responding to Disclosures of GBV
• Session 3-C: Making GBV Referrals
LEARNING OBJECTIVES
After completing this module, participants will have learned:
• The difference between universal counseling versus selective screening for GBV.
• The pros and cons of different FP methods for clients living with intimate partner violence
(IPV) and/or reproductive coercion.
• How to demonstrate active listening during client-centered counseling.
• To explain the purpose and value of psychological first aid.
• The role of quality disclosure response in FP settings.
• Be able to deliver the first three steps of the LIVES approach to first line response.
• When and how to provide referrals for comprehensive first-line response to GBV.
METHODOLOGIES
• Presentation
• Role Play/Skills Practice
• Case Study
• Discussion
MATERIALS NEEDED
• Participant manual for each participant
• Index Cards and string for Web of Referral Activity
ADVANCE PREPARATION
• Review Skills Practice / Role Plays 1–7
• Prepare Web of Referral Activity Cue Cards
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I NTE G RA T IN G G BV -R ESP O NS E IN TO FP A N D RH S ER VI CE DE L IV ER Y | TR A IN ER MA NU A L
MO DU L E 3: G BV - R ESP O NS IV E FP A N D SR H SE RV ICE P RO V I SI O N
Session 3-A: GBV-Responsive Counseling in FP and SRHR
1 H. 30 MIN.
Learning Objectives, Concept of Counseling, and Active Listening (20 min.)
STEP 1
Present SLIDES 1–2. Welcome participants and review the day’s objectives, including:
• Develop foundation skills in GBV-responsive FP and SRH service provision, disclosure response,
and referrals to comprehensive GBV services.
• Develop knowledge and foundation skills on GBV case recording, reporting, and referral
confirmation.
Present SLIDES 3–4. Introduce Session 3-A, letting participants know that they can expect to learn the
following:
• The pros and cons of different FP methods for clients living with intimate partner violence (IPV)
and/or reproductive coercion.
REFERENCE: GBV IN THE CONTEXT OF SRH

Reproductive Health as defined by WHO:37
“Reproductive health is a state of complete physical, mental, and social well-being and not merely the
absence of disease or infirmity, in all matters relating to the reproductive system and its functions and
processes. Reproductive health, therefore, implies that people are able to have a satisfying and safe sex
life and that they have the capability to reproduce and the freedom to decide if, when and how often
to do so.”
37 “Reproductive Health,” World Health Organization, accessed February 3, 2023, https://www.who.int/southeastasia/health-topics/reproductive-health.
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Concept of Counseling
• A two-way interaction between a client and a provider.
• An interpersonal, dynamic communication process that involves a kind of contractual
agreement between a client and a counselor who is trained to an acceptable standard and who
is bound by a code of ethics and practice.
• A process of dialogue and mutual interaction between counselor and counselee aimed at
facilitating problem-solving, motivation, and decision-making of the counselee.
• Requires empathy, genuineness, and the absence of any moral or personal judgment.
PRINCIPLES OF CLIENT-CENTERED COUNSELING

• Privacy; ensure audio and visual privacy.
• Take sufficient time.
• Maintain confidentiality.
• Ask the client about their priorities. Listen to their answer.
• Keep it simple; use common language. Avoid overly scientific/technical words.
• First things first: do not cause confusion by giving too much information.
• Say it again; repeat the most important information at the beginning, in the middle, and the
end.
• Use available visual aids, like posters and flip charts, etc.
• Seek feedback from the client.
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SUMMARY OF TIPS FOR COUNSELING WITH ACTIVE LISTENING
It is important to:
• Use eye contact, as long as this is culturally acceptable in your particular setting. It shows
interest.
• Use open-ended questions. They allow clients to express themselves.
• Check your understanding by summarizing (paraphrasing).
• Nod and use acknowledgment sounds that convey your interest and keep the conversation
flowing, but avoid unnecessarily interrupting your client.
• Use a tone of voice that shows interest.
• Listen for feelings as well as facts.
• Limit active note taking and verbally communicate to the client why you are writing things
down as they speak.
Do not:
• Interrupt the client unnecessarily.
• Finish the client’s sentences.
• Let your mind wander and spend listening time formulating your responses or thinking
about your dinner!
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REFERENCES:
TIPS FOR GENDER-SENSITIVE FP COUNSELING
• Protect the client’s privacy and confidentiality.
• Ensure that counseling is done in a room where others cannot see or hear.
• Do not announce to the waiting area what services the client is at the clinic for.
• Sit at eye level with the client.
• Welcome the client warmly.
• Ask open-ended questions.
• Do not do all the talking.
• Ask about the woman’s relationship with her partner. Under no circumstances should a
woman be denied contraception or a contraceptive method because her husband has not
approved.
• Emphasize the importance of healthy timing and spacing of pregnancy.
• Do not let your own values and biases affect the consultation.
• Provide accurate information, never give wrong information, and if you do not know
something, say you do not know (and will find out).
• Use simple words.
• Encourage the client to ask questions.
• Use visual aids (e.g., a picture, flipchart) if available, or show a person how to do a task as you
explain.
• Listen carefully to what is said and repeat back to make sure you have understood correctly.
SPECIFIC STEPS TO FOLLOW PROVIDING GBV COUNSELING IN AN FP SETTING

• Listen to a survivor’s story.
• Respond to a survivor’s story.
• Assess specific needs.
• Determine how a survivor wants to proceed.
CHECKLIST: INTRODUCTION AND ENGAGEMENT

¨ Greet and comfort the survivor in a warm and open way
¨ Introduce yourself and your role
¨ Discuss all aspects of informed consent, including confidentiality, mandatory reporting, etc.
¨ Answer questions.
¨ Get permission from survivor to continue.
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WHEN TO GET INFORMED CONSENT

• Before you begin an assessment, that is, before listening to a survivor’s story, gathering, or
documenting any information about the person’s case.
• Before making case referrals. Any time you share information with other service providers
who can help the survivor meet their needs, you must seek permission to share information
for each new referral.
• Before you take any other actions on behalf of the person, e.g., carrying out advocacy or case
coordination.
WAYS TO MAKE A CLIENT FEEL MORE AT EASE

Asking a client to talk about what happened to them may feel difficult and scary for them. Here are
some strategies for making a client feel more at ease:
• Using an open-ended question to invite the client to begin, e.g., “Would you like to tell me
about what happened?” or “Can you tell me what brought you here today?”
• Listening carefully to the story as the client tells it.
• Watch a client’s body language closely for any signs of discomfort, such as crying, staring into
space, mumbling, giving one-worded answers, turning away, or changing the topic.
• Actively check in with the client along the way. Consider if they okay with continuing to talk
about this or need a break.
• If the client verbally or non-verbally expresses that they are not comfortable answering
questions or sharing information with you, respect their wishes and stop. Forcing a survivor to
tell their story is harmful. You should not do this under any circumstances.
• Take notes if needed but keep your focus on your client.
• As the client tells you what happened, encourage, and empathize through both verbal and
non-verbal communication. Phrases such as “continue,” “go on,” or “I am listening” can be
helpful.
• Once the client has disclosed, respond to the disclosure with compassion, validation, and
reassurance.
• Ask clarifying questions only after you have let the client speak and have responded to their
disclosure.
• Avoid unnecessary questions; only ask questions that will give you information to help the
client. As you begin this step, you will continue to build trust by fostering a safe environment
in which the person feels listened to, not judged, and not blamed for what happened.
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Activity 2: Presentation and Skills Practice

GATHER Approach Job Aid and Role Play, and IPV/Reproductive Coercion
Considerations in FP Counseling (70 min.)
STEP 1
Present SLIDE 9 on the GATHER approach,38 sharing the following information with participants:
Some of you may already be familiar with the GATHER approach to FP counseling. On page 55 of
your Participant’s Manual, you will find a modified version of this job aid that helps you
remember to give GBV-relevant information.
Remember: you may never know if a person is living with GBV, so offering information on GBV
services and hotlines TO ALL CLIENTS is the best practice. This also reduces stigma if someone is
found to have such information or materials from a clinic.
COUNSELING JOB AID: GATHER APPROACH

• G - Greet the client respectfully.
• A - Ask them about their FP needs. Ask if they have any other concerns about their health or
safety.
• T - Tell them about different contraceptive options and methods, including information on the
FP method’s vulnerability to sabotage and degree of partner involvement needed for proper
use.
• H - Help them to make decisions about choices of FP methods.
• E - Explain and demonstrate how to use the FP methods.
• R - Return, referring and scheduling an appropriately timed return visit. Ask the client for their
preferred method of follow up communication and seek consent to send texts or make phone
calls. Offer information on GBV services and referral availability.
38 Pathfinder International, Comprehensive Reproductive Health and Family Planning Training Curriculum, Module 3: Counseling for Family Planning Services
(Watertown, MA: 1998).
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STEP 2
Present SLIDE 10 focused on IPV/Reproductive Coercion Considerations in FP Counseling, emphasizing
the following points:
Being mindful of the possibility of reproductive coercion and/or IPV triggered by FP use enables
better counseling. Consider including some of these questions (on the slide) in your counseling.
Here are some additional specific points to share with participants:
• IUD strings can be cut short and tucked into the cervical os OR left long and swept behind the
cervix to limit detection by the partner during intercourse.
• Extra pill packs may be given to reduce need for repeat visits if access to a refill site is difficult.
• Emergency contraceptive pills can be taken up to 120 hours after unprotected sex but are most
effective if taken sooner.
IPV/REPRODUCTIVE COERCION CONSIDERATIONS IN FP COUNSELING39
Method Pros Cons Discussion Points

• Does not leave any signs on • With two- and three-month • Are you concerned that
the skin types, monthly bleeding often your partner may track your
Injectable stops after time periods?
• No supplies to store
Contraceptive • Another injection is needed • Do you think you could go
every one, two, or three for re-injection visits without
months, depending on type fail?
• Works well for several years • Sometimes can be felt and • Are you concerned that
seen under the skin of arm your partner may track your
• Usually, no follow-up
Implant periods?
required • May cause spotting or changes
in menstrual bleeding (often
improves after three months)
• Remains out of sight in the • Copper IUD often increases • Are you concerned that
uterus menstrual flow your partner may track your
periods?
• Copper IUD works well for • Hormonal IUD can make
at least 12 years; LNG-IUD, for period lighter or stop • Do you think you may have
Copper or LNG IUD 3–5 years an STI or are likely to get an
• Caution if women has current
STI?
• Usually, no follow-up STI or high STI risk
required
• Partner may feel ends of
• No supplies to store strings in cervix
• Does not leave any signs on • Must be taken every day • Do you have a safe place
skin to keep the pills?
Pill • Pills/packaging must be kept
• Little effect on menstrual in safe place
bleeding
39 Adapted from WHO. Caring for women subjected to violence: a WHO curriculum for training health-care providers. Revised edition, 2021 (Geneva: 2021).
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STEP 3
Project SLIDE 11.
Ask participants to turn to the Role Play activities on PAGES 57–59 of their Participant Manual.
Assign each group one of the following role play assignments:
TRAINER NOTE
Role Plays 1–3 can be found on the following pages:
PAGE
IN TRAINER’S IN PARTICIPANT’S
ROLE PLAY
MANUAL MANUAL
1: Partner IUD Concerns 112 54
2: CEFMU and HTSP 113 55
3: Couple Supported Permanent Method 114 56
Ask participants to read their assignment.
Each person in the group will have a chance to be the client, the provider, and an observer. Instruct
participants to use the information in their participant manual for each role. Each “provider” will have 5
min. to practice counseling using the GATHER approach.
Observers should provide feedback on:

• Did the provider follower the steps and use active listening?
• Did the provider follow client cues to guide discussion and selection of methods?
• Did the provider give information that was GBV-responsive?
Clients should give feedback on:

• Did you feel listened to? Why or why not?
• What did the provider do that was helpful?
• What could the provider have done to make you feel more comfortable?
Explain that they will have approximately 10 min. in their small group before coming together for a
plenary discussion, during which participants will be expected to share feedback. Allow 15 min. group
work and 15 min. for plenary presentation/discussion.
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Session 3-B: Responding to Disclosures of GBV
1 H.
Learning Objectives and Introducing LIV(ES) Psychological First Aid (25 min.)
STEP 1
Present SIDE 12, explaining that participants can expect to learn the following from this session:
• The purpose and value of psychological first aid.
• The role of quality disclosure response in FP settings.
• How to deliver the first three steps of the LIVES approach to first-line response.
Present SLIDE 13, making sure to emphasize the following points:

Using client-centered counseling and active listening will help you identify cases of GBV and
increase the likelihood that a client will choose to disclosure their experiences and fears to you.
So, what then?
As FP providers, you may be the first and/or only person this woman has been able to tell about
what she is dealing with. Your response matters.
Many, if not all people who have survived or are living with GBV, have been made to feel isolated
or as though the violence is their fault. It may be scary for them to share this information with
you. How you respond will impact whether they tell anyone else and whether they choose to
seek additional services.
The act of validating a survivor’s experiencing and affirming their right to safety is called
psychological first aid. It’s just as important as putting a bandage and pressure on a cut to
slow/stop the bleeding before sutures or more advanced care can be given.
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Present SLIDE 14, presenting the LIV(ES) pneumonic to deliver psychological first aid.
JOB AID: LIV(ES) PSYCHOLOGICAL FIRST AID

WHO developed the LIVES pneumonic40 to ensure first-line support in primary and preventative
health care settings that responds to the needs of survivors of sexual assault or intimate partner
violence.
• L - Listen closely with empathy and no judgment.
• I - Inquire. Assess and respond to the client’s needs and concerns—emotional, physical,
social, and practical.
• V - Validate. Show the client you believe and understand them.
• E - Enhance safety. Discuss a plan to protect the client from further harm if violence occurs
again.
• S - Support. Help connect the client to information, services, and social support.
Emphasize the following points to participants:

• The first three steps of the LIVES pneumonic make up psychological first aid and can be
delivered by any level of health worker in any setting where privacy is available. In most
cases, delivering these three steps adds no more than 5 minutes to a client encounter.
• Do not be intimidated by the term “psychological first aid.” Health workers of any level are
qualified to learn how to do this with very simple orientation such as you are receiving today.
Just as physical first aid in the form of a band aid, ice pack, or pressure wrapping is far
removed from surgery; psychological first aid is far removed from advanced psychological
care requiring a mental health professional. But, as in the case of physical first aid, it can
make a tremendous difference.
40 WHO. Caring for women subjected to violence: a WHO curriculum for training health-care providers, revised edition (Geneva: 2021).
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Present SLIDE 15, emphasizing the following to participants:

It can be overwhelming at times when a client discloses violence. It’s appropriate and often
helpful to have some standard phrases ready to use.
Sample Phrases to Use When Providing Psychological First Aid
LIVES STEP SAMPLE PHRASES
• I hear you.
L - Listen • I’m listening.
• We have time if you there is anything else you want to tell me.
• What can I do to help?

• Are you worried about your safety if you tell your partner?
I - Inquire
• How are you feeling? Are you in pain?
• That must have been very difficult.

• I’m so sorry this happened to you.
• You did not/do not deserve this.
V - Validate
• Thank you for telling me.
• Sadly, this happens to many women. You are not alone.
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(LIV)ES Psychological First Aid Role Play (30 min.)
STEP 1
Project SLIDE 16, telling participants:
Let’s practice the first three steps of the LIVES approach with another role play activity. In real
world, you would go on to offer referrals, but you don’t need to do that for this exercise. We will
cover referral to safety planning and other support services this afternoon.
Assign each group one of the following role play assignments:
TRAINER NOTE
Role Plays 4–6 can be found on the following pages:
PAGE
IN TRAINER’S IN PARTICIPANT
ROLE PLAY
MANUAL MANUAL
4: IPV 116 58
5: CEFM 117 59
6: Sexual Violence 118 60
Ask participants to read their assignment.

Each person in the group will have a chance to be the client, the provider, and an observer. Instruct
participants to use the information in their participant manual for each role. Each “provider” will have
five min. to practice counseling using the initial three steps of the (LIV)ES approach.
Reflection Questions:
• How did it feel just to listen and not offer “advice” or solutions?
• What could they have done differently?
Explain that participants will have approximately 15 min. in their small group before coming together for
a plenary discussion, during which participants will be expected to share feedback. Allow 20 min. group
work and 10 min. for plenary presentation/discussion.
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Risk Identification (5 min.)
STEP 1
Present SLIDE 17, telling participants:
As FP providers, in most cases, you should not take on further response services. Many clients
will not choose to act on referrals that you offer. However, there are some signs that your client
is in immediate danger:
RISK IDENTIFICATION
Should you see these signs or behaviors, you may wish to go fetch a GBV specialist colleague
and have them join you in the appointment room:
• The client tells you she is afraid she will be killed if she returns home.
• A client is accompanied by a partner or family member and not allowed to answer questions
for themselves.
• A child under 13 is seeking MR or emergency contraception.
Tell participants:
We will cover referral to safety planning and other support services this afternoon.
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Session 3-C: Making GBV Referrals
1 H. 30 MIN.
Activity 1: Presentation, Discussion, and Case Study

Learning Objectives, Effective Referral Pathway (30 min.)
STEP 1
Present SLIDE 18. Explain that, by the end of this session, participants can expect to learn:
• When and how to provide referrals for comprehensive first-line response to GBV.
STEP 2
Present SLIDE 19, which focuses on Effective Referral Pathway / Case Management Referral System.
REFERENCE: REFERRAL DEFINITION

A referral is the act of officially sending someone to another person or authority—a qualified
professional—to address with the individual’s needs. For any legal assistance to GBV, such as legal
aid, providers may often refer clients/GBV cases to centers where the client can get services,
support, or solutions.
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Share the following point with participants:
As FP providers, YOU are often a client’s point of entry into the health system and offer a crucial
link for onward referrals and additional emergency treatment and/or GBV services.
Ask participants to reflect on the role plays they just completed (when practicing counseling and
provision of psychological first aid).
Ask for a few volunteers to share which clients in those Role Plays would benefit from referral to other
services. Spend 5 min. on this discussion then move to next slide.
STEP 2
Project SLIDE 20. Ask participants to turn to the Case Study 9: Lovely on page 66 of their Participant’s
Manual (page 122 of this Trainer’s Manual).
Instruct participants to take a couple of minutes to read the case vignette to themselves. Once they
have read it, participants should turn to 1–2 neighbors and discuss the questions on the slide. Give
participants 5-10 min., or until you see conversation slowing down—whichever happens first. Ask for
2–3 volunteer groups to share their reflections.

• What are the steps you will follow to counsel her in a real situation?
• In what way you will support the case so she can continue her pregnancy?
• What kinds of referrals might you want to make for this case?
TRAINER NOTE
Additional questions and discussion prompts if necessary based on participant discussion and comments:
• What realistic opportunities are there for male engagement in this situation? As a provider how
might you facilitate positive male engagement?
• Remembering our client-centered principles, is it helpful to Lovely to spend time discussing how
she got into this situation or whether she should have asked for help sooner?
• Given Lovely’s priorities and concerns, which kinds of referrals/additional services will be most
helpful from her perspective?
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One-Stop Crisis Cell, Referral Helplines, and other Referral Locations (20 min.)
STEP 1
Present SLIDES 21–26, providing valuable information for making GBV referrals.
ONE-STOP CRISIS CENTER AND CELLS

The one-stop crisis center (OCC), which was formed in 2001 to provide medico-legal assistance
for victims of physical and sexual assaults, has evolved into a medical treatment center. The goal
of the initiative is to provide all required services for a woman-child victim of violence in one
location.
One of the most significant components of Bangladesh’s Multi-Sectoral Program on Violence
Against Women, OCCs Providing various services to the women and children victims of violence
in one place, including:
• Medical treatment
• Social reintegration
• Safe custody/shelter home
• Rehabilitation
• Psychosocial counseling
• Social welfare services
• Legal support
• Police assistance
• Forensic DNA test
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REFERENCE: ONE-STOP CRIS CENTER CONTACT NUMBERS

Below is a list of OCC Mobile Numbers in Bangladesh, as of January 2023.
OCC Mobile Number of Medical College Hospital in Bangladesh

Name of Medical College Hospital Mobile Number
01 Dhaka Medical College Hospital 01713423490
02 Rajshahi Medical College Hospital 01713366637
03 Chattogram Medical College Hospital 01713366635
04 Sylhet Medical College Hospital 01713366634
05 Khulna College Hospital 01313881919
06 Barisal College Hospital 01713366638
07 Rangpur College Hospital 01755584574
08 Faridpur College Hospital 01755584573
09 Cox’s Bazar Medical College Hospital 01730781039
10 Bogra Medical College Hospital 01730781012
11 Pabna Medical College Hospital 01730781014
12 Kushtia Medical College Hospital 01730781019
13 Jessore Medical College Hospital 01730781024
14 Comilla Medical College Hospital 01713659562
15 Noakhali Medical College Hospital 01713659563
16 Mymensingh Medical College Hospital 01713659564
17 Gopalganj Medical College Hospital 01713659565
OCC Mobile Number of District Sadar Hospital in Bangladesh
Name of District Mobile Number

01 Munshiganj Sadar Hospital 01730781000
02 Narsingdi Sadar Hospital 01730781001
03 Gazipur Sadar Hospital 01730781002
04 Kishoregonj Sadar Hospital 01730781003
05 Netrokona Sadar Hospital 01730781004
06 Tangail Sadar Hospital 01730781005
07 Sherpur Sadar Hospital 01730781006
08 Madaripur Sadar Hospital 01730781007
09 Shariatpur Sadar Hospital 01730781008
10 Narayanganj Sadar Hospital 01730781009
11 Chapainawabganj Sadar Hospital 01730781010
12 Naogaon Sadar Hospital 01730781011
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13 Natore Sadar Hospital 01730781013

14 Sirajganj Sadar Hospital 01730781015
15 Panchagarh Sadar Hospital 01730781016
16 Lalmonirhat Sadar Hospital 01730781017
17 Dinajpur Sadar Hospital 01730781018
18 Meherpur Sadar Hospital 01730781020
19 Chuadanga Sadar Hospital 01730781021
20 Jhenaidah Sadar Hospital 01730781022
21 Magura Sadar Hospital 01730781023
22 Satkhira Sadar Hospital 01730781025
23 Bagerhat Sadar Hospital 01730781026
24 Sunamganj Sadar Hospital 01730781027
25 Habiganj Sadar Hospital 01730781028
26 Jhalokathi Sadar Hospital 01730781029
27 Pirojpur Sadar Hospital 01730781030
28 Patuakhali Sadar Hospital 01730781031
29 Barguna Sadar Hospital 01730781032
30 Brahmanbaria Sadar Hospital 01730781033
31 Chandpur Sadar Hospital 01730781034
32 Lakshmipur Sadar Hospital 01730781035
33 Feni Sadar Hospital 01730781036
34 Khagrachari Sadar Hospital 01730781037
35 Bandarban Sadar Hospital 01730781038
36 Jamalpur Sadar Hospital 01713659550
37 Thakurgaon Sadar Hospital 01713659551
38 Manikganj Sadar Hospital 01713659552
39 Bhola Sadar Hospital 01713659553
40 Narail Sadar Hospital 01713659554
41 Kurigram Sadar Hospital 01713659555
42 Nilphamari Sadar Hospital 01713659556
43 Joypurhat Sadar Hospital 01713659557
44 Rajbari Sadar Hospital 01713659558
45 Gaibandha Sadar Hospital 01713659559
46 Moulvibazar Sadar Hospital 01713659560
47 Rangamati Sadar Hospital 01713659561
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NATIONAL TRAUMA COUNSELING CENTER

The National Trauma Counseling Centre (NTCC) provides psychosocial counseling support
related to violence against women and children totally free of cost, including:
• Individual face-to-face counseling

• Individual tele-counseling
• Couple counseling
• Family counseling
• Group counseling
• Online counseling
For more information, visit http://ntcc-mowca.gov.bd/
NATIONAL CALL LINES

Women affected by violence and in need of services can be referred to an OCC through
Bangladesh’s National Resource Call Lines.
109 National Helpline Centre Offering multisectoral referral and psychosocial support, this
for Violence against Women is the main helpline number to call and is circulated
and Children nationwide. It is a 24-hour-per-day, 365-days-per-year, free
emergency phone service for women and children in need of
aid and assistance.
333 National Hotline Number Immediate reports/help for any social problems, from queries
related to COVID-19 to child marriage and sexual harassment
cases.
10921 National Helpline Center for Immediate service for victims, offering links to relevant
Violence against Women agencies, including doctors, counselors, lawyers, DNA experts,
police officers.
16767 DGFP Call Center Call center that is available 24 hours per day, seven days per
week for any information on FP, maternal and child health,
and nutrition.
999 National Emergency Service A centralized 24-hours-per-day, seven-days-per-week

Bangladesh emergency support service allowing any citizen within the
country border to directly connect with the police, fire, and
ambulance emergency responding teams on the ground to get
aid in an emergency state.
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WHERE TO REPORT
There are several places where you can report:
• One-Stop Crisis Center
• Trauma Counseling Center
• Forensic DNA Laboratory
• National Help Line for Violence Against Women
• Legal Aid Center
• Legal Action Center/Police Station
• Social Support Center/rehabilitation center
• Safe Custody/Shelter Home
• Rehabilitation Center
NATIONAL TRAUMA COUNSELING CENTER

Objective of NTCC
• Provide psychosocial counseling support in NTCC, OCC, and safe home to those experiencing
violence against women and children.
• Conduct different types psychosocial counseling training for Human Resource Development.
• Organize awareness-raising program for changing mindsets.
• Establish a strong network among organizations/stakeholders who work on GBV issues.
Psychosocial Counseling Service

NTCC provides psychosocial counseling support for those experience VAWC free of cost. NTCC
provides a wide range of counseling support including:
• Individual face-to-face counseling
• Individual tele-counseling
• Couple counseling
• Family counseling
• Online counseling
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Present SLIDE 27, emphasizing the following points:

• “Do No Harm” principals call us to limit the number of contacts a survivor will need to go
through. Refer a client directly to the location with the largest number of indicated/desired
services.
• It is also important balance distance and access for the client with privacy and
confidentiality afforded by getting services outside of one’s home community. Let the client
lead when deciding that balance.
INTRA-FACILITY VERSUS INTER-FACILITY REFERRAL
Intra-Facility
• Facility has an emergency department, GBV specialist, and/or other needed services.
• Client has declined legal referral and is seeking medical aid only.
Inter-Facility
• Client has a need and desire for full case management and the full scope of an OCC cell.
• FP service facility does not house:
o GBV subject matter expert
o Necessary equipment and/or commodities for treatment
o Capacity to protect confidentiality of the client
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Activity 3: Presentation, Role Play, and Discussion

Web of Referrals (35 min.)
TRAINER NOTE
You will need to prepare for this activity in advance by creating eight (8) cue cards. See the cue card
instructions on PAGE 123 of this Trainer Manual.
STEP 1
Project SLIDE 28. Introduce the activity objective:
• To better understand and gain empathy for how uncoordinated systems and too much
specialization can make referrals burdensome for a survivor of GBV.
STEP 2
Review directions with participants:
• In this role play, we will follow “Rose” as she seeks help for intimate partner violence.
• We need 9 volunteers. One volunteer will play Rose, and 8 will play people she visits to seek
advice or ask for help.
• Rose will ask each person she visits to take hold of the string that she carries.
• People she visits will have been given a cue card that directs their response and where Rose goes
next.
Step 3
• Ask for a volunteer to play the part of Rose.
• Ask for 8 additional volunteers to play a member of the referral web.
• All other participants will serve as active observers and will be asked to share reflections during
the activity debrief.
Step 4
• Distribute cue cards and role signs to volunteers.
• Give the volunteer playing “Rose” a roll of string or ribbon. Ask this person to hold firmly to one
end of the string and pass the ball to each person they visit.
• Instruct the other 8 volunteers that Rose will visit to hold firmly to the point on the string that
reaches them before handing the ball back to Rose to take with her to her next stop.
• At the end of the exercise, the string will have created a visible web between the many people
that Rose has visited.
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Step 5
Following the activity, conduct a debriefing discussion. Use the following questions to prompt
participants:
• Ask Rose what the experience was like.
• Ask observers to share anything they noticed about:
o Rose’ body language as the referral web progressed
o the way Rose spoke or shared information as the referrals progressed
o if they noticed points in the referral chain where Rose could have been spared a trip
and/or a repetition of her story
• Ask the 8 volunteers (who Rosie visited) to share any reflections they have
• Ask the whole group how this might look different if Rose had an FP visit with a nurse who was
trained to notice signs of IPV and refer her appropriately.
TRAINER NOTE
If participants do not bring up the following issues during the debrief discussion, raise these points
for consideration:
ü Even if individual responses to disclosures of violence are survivor-sensitive and

compassionate, as a provider you might be encountering someone who has already had to
tell their story too many times and/or has had multiple experiences with someone who didn’t
respond appropriately.
ü Referral systems are often complicated and difficult for a client to navigate.
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GBV Referral Slip (5 min.)
STEP 1
Project SLIDE 29. Share the following with participants:
While confidentiality MUST be protected, we also want to confirm referrals and be able to follow
up on care as much as possible. You will need to use a numeric coding system to assign a non-
identifying code to each client referral. This enables tracking without having identifying
information on the referral slip. Records linking numeric codes to client identifying information
should be stored separately and in a locked location. We will discuss more on record storage
when we discuss documentation in the next session.
Let’s practice. Using the case study of Lovely, complete the sample GBV Referral Slip on page 73
in your Participant’s Manual.
Project SLIDE 30 and say:
You can see Lovely’s story again on this slide for your easy reference.
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Tool D: GATHER Approach Counseling Job Aid41
• G - Greet the client respectfully.
• A - Ask them about their FP needs. Ask if they have any other concerns about their health or
safety.
• T - Tell them about different contraceptive options and methods, including information on the
FP method’s vulnerability to sabotage and degree of partner involvement needed for proper
use.
• H - Help them to make decisions about choices of FP methods.
• E - Explain and demonstrate how to use the FP methods.
• R – Return, refer and schedule an appropriately timed return visit. Ask the client for their
preferred method of follow up communication and seek consent to send texts or make phone
calls. Offer information on GBV services and referral availability.
41 Pathfinder International, Comprehensive Reproductive Health and Family Planning Training Curriculum, Module 3: Counseling for Family Planning Services
(Watertown, MA: 1998).
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Role Play 1: Partner IUD Concerns

GATHER Counseling Skills Practice
Provider Info
A woman presents for IUD removal. Her health card indicates that she has two living children and is 25
years old. She is soft spoken and is cradling her left wrist as she speaks to you.
Client Info
You are 25 years old, married, and the proud mother of two children. You and your husband have
received counseling from a FHW and, after the last pregnancy, which was a very difficult one with
complications, have decided to wait some time before having any more children. You were very relieved
when your husband agreed to delay a third child, as he can be very strict and has a big reputation to
uphold in the village.
However, after getting the IUD, during marital relations, your husband complained that he could feel the
IUD and it affected his pleasure. He became angry and rough, shouting that you must find a different
way or just have another child now if God wills it. You are worried he might have injured your wrist as it
has been hurting very much; you can’t use it as normal for household chores.


• What could the provider have done to you feel more comfortable?
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Role Play 2: CEFMU and Healthy Timing and Spacing of Pregnancy

Provider Info
A young woman has just delivered her first baby at the health center. Her client card indicates that she is
16. You are providing PPFP counseling. She is very clear that she does not want any more children at this
time, but states that she cannot take any FP because her husband will be angry.
Client Info
You are happy to be at the health center for a few days and very relieved to have given birth to a
healthy baby boy. A cousin abducted you from your parent’s home when you were 15 and forced you
into wedlock. Your husband can be very cruel and has threatened to take away your visits to your family
if you did not give him a son. At least while at the health center, you are getting some peace and are so
in love with your new baby.


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Role Play 3: Couple-Supported Permanent Method

Provider Info
A middle-aged couple comes to you on referral from their FHW. They are happy with their family of four
children and are interested to hear that there are options to not have any more children. However, they
live a bit far from the health center and are hoping you can help them with something that doesn’t
require them to come back.
Client Info
As a 32-year-old mother of four, you have come with your husband for something to keep you from
having any more children. Your husband doesn’t want you to miss time away from the children and
home, but you have heard about permanent methods and really like the sound of this option has you
won’t have to think about contraception again once it is done. Your sister received bilateral tubal
ligation (BTL) at a mobile clinic a couple of years ago and is always talking about how wonderful it is not
to have to worry about becoming pregnant.


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Tool E: LIV(ES) Psychological First Aid

WHO developed the LIVES pneumonic42 to ensure first-line support in primary and preventative health
care settings that responds to the needs of survivors of sexual assault or intimate partner violence.
• L - Listen closely with empathy and no judgment.
• I - Inquire. Assess and respond to the client’s needs and concerns—emotional, physical, social,
and practical.
• V - Validate. Show the client you believe and understand them.
• E - Enhance safety. Discuss a plan to protect the client from further harm if violence occurs
again.
• S - Support. Help connect the client to information, services, and social support.
42 WHO. Caring for women subjected to violence: a WHO curriculum for training health-care providers, revised edition (Geneva: 2021).
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Role Play 4: IPV

LIV(ES) Skills Practice
Provider Info
A woman presents for IUD removal. Her health card indicates that she has two living children and is 25
years old. She is soft spoken and is cradling her left wrist as she speaks to you.
Client Info
You are 25 years old, married, and the proud mother of two children. You and your husband have
received counseling from an FHW, and after your last pregnancy, which was a very difficult one with
complications, you have decided to wait some time before having any more children. You were very
relieved when your husband agreed to delay a third child, as he can be very strict and has a big
reputation to uphold in the village.
However, after getting the IUD, during marital relations, your husband complained that he could feel the
IUD and it affected his pleasure. You reminded him that it was dangerous for you to become pregnant
again and this was protecting your life, but he became angry and grabbed your wrist, bending your hand
back until your cried out. You haven’t been able to use your wrist as normal for household chores, but
your husband tells you not to be weak. Finally, you ask for permission to go to the health center to have
the IUD removed, and he agrees.
You do want the IUD removed so your husband stops being angry, but you also really hope the doctor
can help your wrist.
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Role Play 5: CEFM

Provider Info
A young woman has just delivered her first baby at the health center. Her client card indicates that she is
16. You are providing PPFP counseling. She is very clear that she does not want any more children at this
time, but states that she cannot take any FP because her husband will be angry.
Client Info
You are happy to be at the health center for a few days and very relieved to have given birth to a
healthy baby boy. A cousin abducted you from your parent’s home when you were 15 and forced you
into wedlock. Your husband can be very cruel and had threatened to take away your visits to your family
if you did not give him a son. At least while at the health center, you are getting some peace. You are
very worried about going back home. Your husband beats you when he isn’t satisfied with your
housework, and you already feel so tired from caring from your new son.
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Role Play 6: Sexual Violence

Provider Info
A woman comes to the clinic asking for MR. She hesitates when you ask for her name and does not have
her ID card with her. She says she is due to begin bleeding in one week but has heard the clinic can make
sure her menstruation comes and that she does not end up with a baby.
Client Info
Your husband has been away to find work these past six weeks. Last night, a neighbor came by to ask
how you were doing, but he insisted on coming into the house and forced you to have sex. You are so
scared you will become pregnant because your husband would know it was not his child.
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Case Study 9: Lovely
Lovely Begum (pseudonym) is only 16 years old. Her parents had arranged to have her married to a
nearby acquaintance when she turns 18, but a jealous cousin abducted her and forced her into wedlock.
She tried to escape to her parents’ home after that the cousin made her isolated from everyone in the
family, but her parents explained that because the marriage had been consummated, her previous
betrothed will not take her anymore and told her she needed to go back to her husband.
Lovely returns to her husband’s house. Her husband continues to keep her at home and does not allow
her to visit her parents anymore. He is angry that she tried to stay at her parents. He yells at Lovely and
beats her frequently. He accuses Lovely of not getting pregnant on purpose.
Finally, after six months of life as a wife, Lovely discovers she is pregnant and goes to the SRH service
center to get help for continuing her pregnancy. She is very worried about protecting her precious child
in her womb and concerned that the beatings she is receiving at home will harm her child.

• What are the steps you will follow to counsel her in a real situation?
• In what way you will support the case so she can continue her pregnancy?
• What referral pathway you will follow to refer her and where to refer this case?
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MO DU L E 3: G BV - R ESP O NS IV E FP A N D SR H SE RV ICE P RO V IS IO N
Role Play 7: Web of Referral

Cue Card Content
TRAINER NOTE
Prepare the cue cards in advance of the activity. You may either print and fold a piece of paper or
use two sides of a note card. The important thing is that everyone can see one side of the cue card
where the name/role is easily visible, but only the individual playing this role (holding the cue
card) can see the speaking/acting prompts on the reverse side of the card.
CUE CARD 1
Front (visible to everyone): Client - Rose

Back (visible to “Rose” only): You are Rose, a 24-year-old woman who has been experiencing physical
and sexual abuse from your boyfriend for the last six months. You don’t know what to do and you are
scared for your life. You want help leaving your boyfriend, so he won’t hurt you when you say it is over.
You go to your sister for support and advice.
CUE CARD 2
Front: Sister
Back: Listen to Rose, talk to her, and encourage her to work things out. Then send her to a
community/religious leader for better guidance.
CUE CARD 3
Front: Religious Leader

Back: Listen to Rose, talk to her, and explain that this is really a women’s issue. Then give her the name
and phone contact for a member of the local women’s group for support.
CUE CARD 4
Front: Women’s VAWG NGO Volunteer

Back: Listen to Rose, talk to her, and then send her to a health clinic for first line support.
CUE CARD 5
Front: Doctor at Clinic #1

Back: Listen to Rose, talk to her, and then send her to the police to file an official complaint. You wish
young women would realize that this is why intimate relationships outside of marriage are a bad idea.
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CUE CARD 6
Front: Officer at Police Station #1

Back: Listen to Rose, talk to her, and then send her to a One-Stop Crisis Center. Explain that no charges
can be filed as she did not bring a forensic report and so there is no medical proof.
CUE CARD 7
Front: Nurse at Clinic #1

Back: The doctor Rose saw previously is not working today. Listen to Rose, talk to her, take her history,
perform a medical examination, and then send her with medical details and a formal exam report back
to the police.
CUE CARD 8
Front: Officer at Police Station #2

Back: Listen to Rose, talk to her, and then send her to a legal aid lawyer.
CUE CARD 9
Front: Legal Aid Lawyer

Back: Ask Rose to tell her story, ask for all the documents, and then make her tell her story again to
practice telling it in court if the prosecution gets that far.
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Tool F: GBV Referral Slip
REFERRAL SLIP
Client number (as recorded):
Name of client (first name only/optional):
Age:
Gender:
Immediate management given (if any): first aid / LIV / Helpline info
Cause of referral:
Place of referral:
Date referral completed:
Source: Pathfinder International
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Module 4: Foundational Knowledge of GBV

Case Recording, Documentation, and Record
Keeping
TOTAL MODULE TIME: 45 MIN.
• Session 4-A: Legality, Protecting Confidentiality, and Reporting GBV
LEARNING OBJECTIVE
After completing this module, participants will have learned:
• About the legality and reporting aspect of a GBV case identification, notification to primary
management, and referral.
METHODOLOGIES
• Presentation
• Case study / Skills practice
• Discussion
MATERIALS NEEDED
• Participant manual for each participant
ADVANCE PREPARATION
• Review Case Study / Skills Practice 8: Aklima
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MO DU L E 4: G BV CA S E RE CO RD IN G , DO CUM ENT A TI O N, A N D R EC O RD K EE PI NG
Session 4-A: Legality, Protecting Confidentiality, and Reporting GBV
45 MIN.
Learning Objectives, Legality, Confidentiality, and Reporting (10 min.)
STEP 1
Present SLIDES 31–32, highlighting what participants can expect to learn from this session:
• Gain an understanding of the legality and reporting aspect of a GBV case identification,
notification to primary management, and referral.
STEP 2
DEFINING “LEGALITY”
Legality is an act, agreement, or contract that is consistent with the law or state of being lawful
or unlawful in a given jurisdiction, and the construct of power. Legal assistance describes a
range of legal services, from the provision of generic legal information and advice to
representation by a legal professional in court.
LEGAL CONSIDERATIONS FOR FP AND SRH PROVIDERS AROUND GBV

• Health care providers do not have a legal mandate to report GBV. You should only report
cases to judicial authorities if and with a client’s written consent.
• Documentation of disclosure, injuries, or other medical records may become evidence in the
event a survivor chooses to file a legal complaint and prosecution follows.
• The universal provision of referral options and GBV services available is not legally required
but is ethically mandated.
Emphasize the following to participants:

How, what, and when you document matters!
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TRAINER NOTE
Tell participants that while they now know how to solicit and receive disclosures of violence and
make referrals to additional services, there is one more critical piece of providing GBV-responsive
services: Documentation and reporting. Reiterate that this does not refer to legal reporting, but
rather to service provision reports just as for any other services given at the facility. BUT – there
are unique considerations for GBV.
INTEGRATING GBV DISCLOSURE AND RESPONSE REPORTING INTO AN FP AND SRH VISIT
• Use separate forms provided. GBV disclosures should NOT be noted in the regular FP
register.
• Immediately following the visit, place your documentation form in an assigned, locked
storage space.
• Document in three places: confidential client record, referral slip, and anonymized
facility log.
What to Include in Your Report

• Basic demographic information
• Consents obtained
• History
• Account of the assault
• Results of the physical examination
• Tests and results
• Treatment plan medication provided or prescribed
• Referrals provided
• Anonymous code for use in referral communication
• Information shared by client
• Provider observations
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Activity 2: Presentation, Skills Practice, and Discussion

GBV Referral and Report (35 min.)
STEP 1
Project SLIDE 36, featuring a sample facility register for recording cases of GBV. Note the following
to participants:
Referral completion should be marked Y or N based on completion status at time of one week
follow-up.
STEP 2
Project SLIDE 37. Ask participants to turn to Case Study 10: Aklima on page 78 of their Participant’s
Manual (page 132 in this Trainer’s Manual).
STEP 3
Ask participants to please work on their own or with a partner. Take the next five minutes to read
Aklima’s story.
Then, using the sample referral and GBV record forms in their manual, fill out the documentation
needed based on the information in Aklima’s study. Everyone has 10 min. to fill out the forms before
coming together again for reflection and plenary discussion.
STEP 4
During the plenary, ask the following questions to generate discussion:
• What was the hardest pieces of the form to complete?
• Do you think you will be able to do this during a normal day of work?
• Do you have any questions on how to fill out a certain portion of the forms?
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Tool G: Sample GBV Disclosure Client Report Form
Client Name: Age: Sex: Case Code:
Forms of GBV disclosed (circle all that apply):
Physical abuse Sexual abuse (partner) Contraceptive sabotage Sexual assault (stranger)
Attempted assault
Threat-based reproductive coercion
(stranger)
Client consents to be contacted for follow

By phone: By SMS: Other:
up: Y/N
Okay to leave voice mail: Y/N
Any observed marks or injuries:
Referrals offered (circle all that apply):
Clinical management of Other emergency Psycho-social support/ Legal services

rape medical treatment case management
Referral location: Date referral issued:
Referral completed: Y/N/Unknown Date referral completed:
Provider signature:
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Tool H: Sample Facility Register Source: Pathfinder International
Date of incident
Date of visit
Case Code
Client age
Client sex
Type of GBV Response
Contraceptive Sabotage
Referral Completed*
Treatment (first aid)
Police Report Made

Sexual (non-IPV)
Referral Issued
Sexual (IPV)
Emotional
Physical
LIV(ES)
23/9/2022 19/9/22 922-05 F 22 X X X X N
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Case Study 10: Aklima
Referral and Report Skills Practice

Aklima, age 28, is a married, mother of three. She has been using a Copper-T intrauterine device
(IUD) for two months. Aklima’s husband, Rahim, is very strict and beats her when he is not pleased
with her housework, the children’s behavior, Aklima’s appearance, or her way of speaking in front of
his friends. During her last pregnancy, Aklima was very worried the beating would hurt her child, and
she ended up delivering early. The baby was very small, and the child tends to be sickly. Aklima
wants to avoid another pregnancy for the sake of her children and to be able to carry out her duties
in a way that is pleasing to her husband.
During the visits to the clinic to receive her Copper-T, Aklima shared that she wanted to prevent
another pregnancy so she could better please her husband. The FP counselor offered her
information about feeling safe in one’s home and gave her the national hotline number, but Aklima
did not call. Aklima felt this would only make her situation worse. And she knew her husband would
be very angry if he found out she had complained about him. The FP counselor also gave Aklima
information about the Copper-T, its safety, and that it had no impact on hormones or future fertility.
One night, Rahim came home late. He seemed upset and impatient, criticizing dinner and the
children’s cleanliness. In the marriage bed that night, Rahim became very angry. He blamed Aklima
and the Copper-T on not being able to perform, and he beats her very badly. In the morning, Aklima
has a black eye, is missing a tooth, and is afraid her wrist may be broken. As soon as the children go
to school, Aklima rushes to the health center to have the Copper-T removed.
The nurse assistant in the waiting area notices Aklima’s appearance and goes to fetch a GBV
counselor to join the appointment. Once in the exam room, Aklima states that she would like the
Copper-T removed. The counselor asks why and if she would like another method. Aklima bursts into
tears and shares her whole story. The counselor provides psychological first aid and recommends
that Aklima been seen at the OCC help center where she can get treatment for her injuries, find a
new FP method, and receive other GBV services all in one place. The counselor assures Aklima that
she can be seen today and that there will be no open record of the referral or where she goes.
Aklima agrees. The counselor completes the client record card and tells Aklima it will go into a
private, locked storage box. She also completes the OCC referral slip and gives Aklima directions to
the nearest MCH unit. The FP provider completes the FP register noting that no method was given
and also completes the anonymized GBV register.
Later that day at the end of her shift, the FP provider calls the OCC to inquire which case codes have
come in and can be marked as completed referrals.
Using the sample referral and GBV record forms, fill out the documentation needed based on the
information from Aklima’s story.
For Reflection and Group Discussion

1. What was the hardest pieces of the form to complete?
2. Do you think you will be able to do this during a normal day of work?
3. Do you have any questions on how to fill out a certain portion of the forms?
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Tool I: Sample Facility Report of Services for GBV

Individual disclosure forms must be kept confidential and only accessed as needed for case
management, clinical follow-up, and/or legal inquiry. However, anonymized aggregate reporting is
critical for facility and health system management. This type of reporting will help facility, upazila,
and district managers appropriately allocate staff, forecast and order necessary supplies and
equipment, and plays a role in sensitizing policy makers on the prevalence and severity of GBV faced
by their constituents. Participants may share this sample form with their ward head and/or facility
manager if they are not participating in this training.
Total no. GBV Total no. GBV Total no. GBV Total no. GBV
Total
client identified client managed client referred client followed
Facility
SI #
name
Female
Female
Female
Female
Female
Others
Others
Others
Others
Others
Male
Male
Male
Male
Male
UH&FWC
total
Health
post
total
Reporting month/year:
Union Upazila District
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MO DU L E 5: CL O SI NG
Module 5: Closing

• Session 5-A: Closing and Post-test
LEARNING OBJECTIVES
• Be able to provide feedback on this training
• Share what they learned
• Find additional resources
METHODOLOGIES
• Presentation
• Assessment
MATERIALS NEEDED
• Tool A: Pre- and Post-Test Assessment
• Tools K and L: Competency Assessment Checklists
• Tool M: Training Evaluation
• Participant’s Manual for each participant
ADVANCE PREPARATION
• Be sure to read all instructions for Module 5 carefully. Multiple closing activities are intended
to be managed simultaneously by the facilitation team.
• Print enough copies for of the Tool B: Post-test Assessment for all participants, plus 2-3 extra
copies.
• For each participant, print Tools K and L—the competency assessment checklists.
• Print sufficient copies of Tool M: Training Evaluation for all participants.
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Session 5-A: Closing and Post-Test
1 H. 30 MIN
TRAINER NOTE
As a facilitation team, plan in advance who will give instructions and guide the main group during
the closing session and who will be taking participants aside for skills evaluation. During periods
when participants are engaged in independent work, e.g.: the post-test and training evaluation, all
facilitators should be engaged in skills assessment.
To complete assessments for each participant in the available time, it is important to keep the
simulation brief. Be sure to set expectations that these are mini scenarios and not full role plays.
Activity 1: Presentation and Discussion

Wrap-up (20 min)
Step 1
Present SLIDE 38 and SLIDE 39.
Congratulate the group on reaching the end of the training. Review key messages:
ü FP/SRH providers have a critical role to play in first line response for violence against women
and girls.
ü Basic services such as GBV-responsive FP method counseling, psychological first aid, and
appropriate activation of a referral chain can have significant impact on the trajectory of
care for people living with GBV.
ü FP/SRH providers have a significant role to play in safe, confidential reporting and
documentation of GBV prevalence and incidence.
STEP 2
Direct participants attention to the wall and/or flip chart of expectations from the opening session
on Day 1. Review expectations and how various activities or discussion highlights from the past two
days met these expectations.
STEP 3
Ask for a few volunteers to share 1 thing they will be taking away from this training.
STEP 4
Project SLIDE 40 and introduce the final elements: a self-reflected action plan; post-test and training
evaluation, and a skills assessment.
Tell participants that facilitators will be pulling them aside throughout this session for their skills
assessment. They will have plenty of time for the other activities, regardless of when they are pulled
for their assessment.
135
Send the first participant over to the assessing trainer.
Activity 2: Presentation and Reflection

Individual Action Plan (35 min)
Step 1
Ask participants to turn to the Individual Action Plan on page 81 of their Participant’s Manual (page
138 of this Trainer’s Manual).
Emphasize that these plans are individual and based on their own work context, stage of
professional development, and typical clients. FP and RH providers working in FP clinics, versus those
working in referral hospitals, are likely to have different goals.
Tell participants that you are available if they have questions as they work on their plans and need
only raise their hand.
Activity 3: Assessment
Post-Test and Training Evaluation (35 min)
STEP 1
Distribute Tool A: Pre- and Post-Test Assessment (see page 26 of this Trainer’s Manual) for
participants to complete.
Remind participants to write the same 3- or 4-digit number or code that they wrote on their Pre-
test. This is very important.
STEP 2
While everyone is completing their Post-test Assessment, begin pulling individual participants aside
to complete their Skills Assessment using the following tools:
• Tool K: GBV-Responsive FP Counseling Competency Checklist (see page 139 of this Trainer’s
Manual)
• Tool L: Responding to Disclosures of Violence - LIV - Competency Checklist (see page 140 of
this Trainer’s Manual)
Set the stage by telling the participant that, in this final role play, they are taking the role of FP
provider during a routine FP visit. The consult room has a fabric partition between two service
spaces. They are sharing the room with another provider.
Scenario information for the assessor to use during the role play:
You are a 24-year-old married woman. You have completed three years of university and
have one young child who is now six months old. Your husband was supportive of you
completing your university degree, and you have been planning on returning to complete
your final year when the next semester begins—now that your baby has started eating solid
foods.
However, since the baby arrived, life has become much harder. Your husband is always
finding fault with the housework and often yells at you and even smacks you because there
are nights when you are busy with the baby and don’t go to your husband’s bed. Your
136
husband has told you he will just use condoms for a few months because he wants another
baby as soon as you finish your degree so you can become pregnant in a few months.
You are very worried about how hard life will be if you become pregnant again. You worry
about whether you can even go back to university without making your husband angrier and
getting beaten more often.
When first asked what brings you in to the clinic, you simply tell the FP provider that you
have heard there are ways to make sure you do not get pregnant for a few years that a
husband would not notice. If the provider makes you feel comfortable, you may choose to
disclose additional information about your home troubles.
STEP 3
Distribute Tool M: Training Evaluation (see page 141 of this Trainer’s Manual) for each participant to
complete by walking around and placing the evaluation facedown by participants approximately 15
min. after they start their knowledge Post-test Assessment.
137

Tool J: Individual Action Plan: Improving GBV-Sensitive FP Service
Provision
I understand that to provide GBV-sensitive FP services, I need to:
✓ Support GBV-sensitive communication.
✓ Promote reproductive agency by encouraging clients, whether men or women, to make
their own reproductive choices, regardless of their age, marital status, or consent by a
spouse or family members.
✓ Engage men and boys as supporters and users of FP.
✓ Facilitate positive couple’s communication and cooperative decision-making.
✓ Respond to GBV through empathetic counseling and referrals, and respect and maintain
confidentiality on a woman or couple's use of a FP method.
Name
Specific action you can Why you want to make Challenges you might Strategies to overcome
implement immediately this change encounter challenges
1.
2.
3.
Notes
138
Tool K: GBV-Responsive FP Counseling Competency Checklist
GBV-Responsive FP Counseling Participant Code
Competency Meets Not Observed

Begins the appointment by asking
if the client is comfortable with
the people present or would like
to have their appointment in
private.
Inquiries about the client’s
current needs and priority
concerns. Uses open-ended
questions to inquire if the client
has any safety concerns.
Contraceptive method counseling
includes information on visibility
and risk of tampering by method.
Total competencies met:
Participants should meet 3/3 competencies. If a participant meets 0/3 or 1/3 competencies, they should be
referred for further coaching and on-the-job support to their clinical supervisor.
139
Tool L: Responding to Disclosures of Violence - LIV – Competency

Checklist
Responding to Disclosures of Violence - LIV Participant Code
Competency Meets Not Observed

Listens to information shared
with open body language and
without interrupting
Does NOT ask about curiosity
details (e.g.: why did that
happen?)
Validates client experience and
feelings. Example responses
include:
ü That must have been scary.
ü I can hear how hard that
was.
ü You are not alone. Many
women struggle with such
things.
Assures the client the violence is
not their fault.
Informs the client that help, and
support are available nearby.
Offers to share referral options.
Total competencies met:
Participants should meet 5/5 competencies. If a participant meets fewer than 3 competencies, they should
be referred for further coaching and on-the-job support to their clinical supervisor.
140
Tool M: Training Evaluation

Instructions: Please evaluate the training by responding to the statements below. Kindly score each
statement from 1 to 5, with 1 being the poor and 5 being excellent. Where the statement does not
apply to the session, please note N/A in the comments column. The final score should be indicated,
with the exclusion of the statements marked as N/A. This is an anonymous process.
Province: _________________Venue: __________________Date: ________
Content Evaluation 1 2 3 4 5 Comments

The content was presented clearly.
The standard of the content presented was of high quality.
The content was relevant to the training.
The information is up to date and well researched.
I gained new knowledge and skills.
The session that was of most value (give the session a score
and write which session in the comments column).
The session that was of least value (give the session a score
and write which session in the comments column).
Adequate time was allocated for all the sessions of the day.
Presentation/Organization/Preparation 1 2 3 4 5 Comments
The training schedule was well prepared.
The flow/transition between sections/topics was logical and

easy to follow.
All topics presented were linked to real-life

situations/experiences/current events.
Activities conducted were relevant to the topic and allowed

participants to reflect on what was being discussed.
Handouts were prepared and distributed when they were to

be used.
141
Delivery of Content 1 2 3 4 5 Comments

The trainers/facilitators maintained a level of
Professionalism throughout in a nonthreatening manner.
The trainers/facilitators were confident about presenting the

topics.
The trainers/facilitators spoke clearly and projected their

voices.
All participants were engaged in the activities and listening.
The trainers/facilitators encouraged participation throughout.
The trainers/facilitators responded knowledgeably and

appropriately to questions.
The trainers/facilitators did a summary at the end of all

sessions and activities.
The session was concluded with a summary that reflected

valuable information.
Distractions and interruptions were managed appropriately.
Overall rating of the training
Overall time management rating:
General comments on how to strengthen the training, if any
142
References
Bangladesh Bureau of Statistics, Statistics and Informatics Division, Ministry of Planning, Government of the
People’s Republic of Bangladesh, Report on Violence Against Women Survey 2015 (Dhaka, Bangladesh: 2016).
Breakthrough ACTION. Advancing male engagement in family planning and reproductive health: An advocacy
tool. Johns Hopkins Center for Communication Programs (Baltimore: 2018).
Claudia Garcia-Moreno, et. al. “WHO Multi-country Study on Women's Health and Domestic Violence against
Women Study Team. Prevalence of intimate partner violence: findings from the WHO multi-country study on
women's health and domestic violence.” Lancet. 2006; 368 (9543): 1260–1269.
Ellen Starbird, Maureen Norton, and Rachel Marcus. “Investing in Family Planning: Key to Achieving the
Sustainable Development Goals,” Global Health: Science and Practice, 2016 Jun 20; 4(2): 191–210.
Faramand TH and Treleaven E. Integrating Gender in Improvement Activities. Implementation Guide. USAID
Health Care Improvement Project. (Bethesda, MD: University Research Co., LLC (URC): 2012).
“Handout: Gender-related Terms and Definitions,” IGWG, accessed January 23, 2023,
https://www.igwg.org/wp-content/uploads/2017/05/HandoutGenderTerms.pdf.
MEASURE Evaluation. Male Engagement in Family Planning Indicator Brief, 2018.
Nashid Tabassum Khan, et. al., “Violence against Women in Bangladesh.” Delta Med Col J. 2017; 5 (1):25–29.
National Institute of Population Research and Training (NIPORT), Mitra and Associates, and ICF International.
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NIPORT, Mitra and Associates, and ICF International.
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Survey 2017-18: Key Indicators (Dhaka, Bangladesh, and Rockville, Maryland, USA: 2019).
Pallitto, C. C., Campbell, J. C., & O’Campo, P. (2005). Is Intimate Partner Violence Associated with Unintended
Pregnancy? A Review of the Literature. Trauma, Violence & Abuse, 6(3), 217–235.
http://www.jstor.org/stable/26636659.
Pathfinder International. Comprehensive Reproductive Health and Family Planning Training Curriculum,
Module 3: Counseling for Family Planning Services (Watertown, MA: 1998).
“Reproductive Health,” WHO, accessed February 3, 2023, https://www.who.int/southeastasia/health-

topics/reproductive-health.
Rowlands S, Walker S. (2019). “Reproductive control by others: means, perpetrators and effects.” BMJ Sexual
& Reproductive Health; 45:61-67: https://srh.bmj.com/content/45/1/61.
“Sexual health: definitions,” WHO, accessed January 20, 2023, https://www.who.int/health-topics/sexual-

health.
Sidney Ruth Schuler, Syed M. Hashemi, and Ann Hendrix Jenkins. “Bangladesh’s Family Planning Success Story:
A Gender Perspective.” International Family Planning Perspectives, Volume 21, Number 4, December 1995.
UN Women. Measuring the Shadow Pandemic: Violence Against Women During Covid-19: Country Report:
Bangladesh (New York: 2022).
WHO. Caring for women subjected to violence: a WHO curriculum for training health-care providers, revised
edition (Geneva: 2021).
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WHO. Core competencies in adolescent health and development for primary care providers: including a tool to
assess the adolescent health and development component in pre-service education of health-care providers
(Geneva: 2015).
WHO Department of Reproductive Health and Research. Global Plan of Action: Health systems address
violence against women and girls (Geneva: 2016).
WHO. Gender mainstreaming for health managers: a practical approach (Geneva: 2011).
WHO. Health care for women subjected to intimate partner violence or sexual violence: A clinical handbook
(Geneva: 2014).
WHO. Violence against Women Prevalence Estimates, 2018. Global, regional and national prevalence estimates
for intimate partner violence against women and global and regional prevalence estimates for non-partner
sexual violence against women (Geneva: 2021).
World Bank. World Bank Group Gender Strategy (FY16-23): Gender Equality, Poverty Reduction and Inclusive
Growth (Washington, DC: 2015).
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144
145
Integrating Gender-Based Violence Response
into Family Planning and Reproductive Health
Service Delivery
—Day 1—
Module 0
Introduction to Training
INTEGRATING GBV-RESPONSE INTO FP AND RH SERVICE DELIVERY SLIDE 2
MODULE 0 | SESSION A
Introductions, Group Norms, and Pre-Test
INTEGRATING GBV-RESPONSE INTO FP AND RH SERVICE DELIVERY MODULE 0 | SESSION A | SLIDE 3

Overall Goal of Training
Advance knowledge and skill set of family planning (FP) and
sexual and reproductive health (SRH) service providers to
address gender-based violence (GBV) and provide GBV-
responsive care within FP/RH service interactions.

Learning Outcomes
• Gain greater understanding and • Master skills required to deliver the
knowledge of gender norms, dynamics, first three steps of the LIVES
equity, and their role in GBV. pneumonic for disclosure response.
• Gain a greater understanding of how • Gain knowledge on how to refer GBV
GBV manifests in FP and SRH service survivors to appropriate service
provision and uptake.
providers/facilities in a safe and
• Increase knowledge of how GBV is ethical way.
relevant to FP services, including GBV
risk identification and analysis. • Develop skill sets to manage GBV case
recording and reporting during FP and
• Gain skills to mitigate and respond to SRH service provision.
GBV threats within the context of FP
and sexual and reproductive health
and rights (SRHR) activities.

Module 1
Understanding Gender and GBV
INTEGRATING GBV-RESPONSE INTO FP AND RH SERVICE DELIVERY MODULE 1 | SLIDE 6
Understanding Gender in FP Services
What You Can Expect to Learn

Gain clear concepts of gender, gender equity and equality, and their
impact on power and violence.

What Does Gender Mean to You?
Turn to a person near you and share reflections
based on these three questions:
1. Share a time when you became aware of your gender.

2. Describe a time when you felt happy about your gender.
3. Has there been a time when you felt scared,
discriminated against, or sad because of your gender?

Definition of Gender
Gender is about the roles, norms, and behaviors that society
consider appropriate for women, men, girls, boys, and those with
diverse gender identities, such as transgender. These are socially
constructed and vary widely within and across cultures, religions,
class, and ethnicity. For example, in many societies a common
gender norm is that women and girls should do most of the
domestic work.

It’s not fair or equal…
WOMEN ARE HALF THE WORLD’S POPULATION.
YET, WOMEN LIVE WITH A 3X GREATER LIFETIME EXPERIENCE

OF GENDER-BASED VIOLENCE. IN LOW AND MIDDLE INCOME
COUNTRIES, GENDER DISCRIMINATION RESULTS IN AN
ESTIMATED 3.9 MILLION EXCESS DEATHS AMONG WOMEN
AND GIRLS BY THE AGE OF 60.
Source: World Bank

Let’s Try a Gender Quiz
Please read each statement below carefully. Then check the
appropriate box to answer the question:
Does this issue relate to sex or does it relate to gender?

Understanding the Difference Between Sex and Gender

Key Terms
Gender Norms Gender Equity
What society considers male and female The absence of discrimination based on a
behavior, leading to the formation of person’s sex or gender. Gender equity
gender roles, which are the roles men and means providing the same opportunity to
women, and boys and girls, are expected each person, including access to and
to take in society.
control of social, economic, and political
Gender Awareness resources, including protection under the
An awareness of the differences in roles law, such as health services, education,
and relations between women and men. It and voting rights.
recognizes that the life experiences,
expectations, and needs of women and
men are different, varying across the
culture and society.

Key Terms continued
Gender Discrimination Gender-Based Violence (GBV)
Any distinction, exclusion, or restriction Any act that is perpetrated against a person’s
made on the basis of socially will and is based on gender norms and
constructed gender roles and norms, unequal power relationships. This includes
which prevents a person from enjoying threats or acts of coercion, arbitrary
full human rights. deprivation of liberty, neglect, or
discrimination, whether occurring in public
Gender-Related Barriers or in private life. GBV encompasses physical
Obstacles to access and use of health or sexual assault, emotional or psychological
services, which are related to deep- harm, denial of resources or access to
rooted social and cultural norms about services, and denial of legal self-autonomy.
the roles of women, men, and those
with diverse gender identities.

Understanding Gender and Power
Power is the capacity or ability to direct or influence the behavior of self, others, or
the course of events.
Power Over: an individual or institution’s degree of power translates to their capacity to exploit
others, regardless of intention or action to do so.
Power To: an individual or institution’s capacity to create without using relationships of domination.
The capacity to act and to exercise agency and realize the potential of goals, rights, or aspirations.
Power Within: a person’s sense of their own capacity and self-worth. It is related to the productive
sense of ‘power to’ and a prerequisite to holding or increasing one’s ‘power to.’
Power With: collective power within, to, or over that comes from intentional solidarity amongst
individuals or groups. This collective power can be mobilized both within and across class, caste,
religious, gender and age differences.

Power and GBV
Any action, threat, or The greater the

exercise of control power an individual
Intersectional factors
that uses gender or institution holds,
increase or decrease
roles and norms to the easier it is for
a person’s
decrease a person’s them to perpetrate
power is gender- vulnerability gender-based
based violence. violence.

Case Study 1: Rahima
• What elements of Rahima’s story demonstrate the common gender norms and expectations
• Do you see examples of the men and women in Rahima’s story having different levels or
• Do you think that gender norms and gender-specific power influences the FP choices in
• Do you see examples of GBV in Rahima’s story? Why or why not?

MODULE 1 | SESSION B
Gender Relevance in FP Success and Failure

• Gain insights into gender role in FP success and failure, including how failure can
be transformed into a success story.
• Be able to articulate the relevance of gender discrimination and GBV to optimize
FP and SRH services.
INTEGRATING GBV-RESPONSE INTO FP AND RH SERVICE DELIVERY MODULE 1 | SESSION B | SLIDE 18

Questions to Assess How Gender Affects FP and RH Outcomes

The Power of FP for Women and Development
“Investing in family planning is

a development ‘best buy’ that
can accelerate achievement
across the 5 Sustainable
Development Goal themes of
People, Planet, Prosperity,
Peace, and Partnership.”
Source: Ellen Starbird, Maureen Norton, and Rachel Marcus.
“Investing in Family Planning: Key to Achieving the Sustainable
Development Goals,” Global Health: Science and Practice, 2016
Jun 20; 4(2): 191–210.

Bangladesh has achieved historic progress in expanding
access to voluntary contraception for nearly half a century.
Increase in Contraceptive Use Decrease in Total Fertility Rate

Bangladesh’s Historic FP Progress
• One of the oldest family planning programs in the world (launched 1953).
• In less than 50 years, percentage of married women of reproductive age who
are using family planning increased sevenfold.
• Today, contraceptive prevalence rate is 62 percent, and 52 percent of women
are using modern contraceptive methods.*
• GOB and DGFP has strong commitment and farsighted vision for FP program.
Source: BDHS 2017–2018

Opportunities for Progress
• Address high rates of discontinuation: 37% of contraceptive users
stop their selected method within 12 months.
• Improve service quality and method mix: only 9% of currently
married women are using a long-acting or permanent method.
• Address unmet need among adolescents: 16% of adolescents ages
15–19 have an unmet need for FP, compared to 5% among women at
the end of their childbearing years (45–49)
• Improve services offered to women who were or are child brides:
Nearly one-third (31%) of women ages 20–49 report that they had
married by age 15.
Source: BDHS 2017–2018

Case Studies 2–5: Hena, Nazma, Rani, and Mr. Hossain
• Where do see gender and power helping achieve good FP and SRH?

Other Relevant Barriers
• Stock outs • Opportunity costs

• Lack of funding • Service provider bias
• Lack of skilled service providers • Legislative and legal barriers
• Distance to health service point • Cultural norms and traditions
• Misinformation in communities

Module 2
Foundations in GBV
Understanding and Conceptualizing GBV

• Be able to articulate the many different forms and manifestation of GBV.
• Understand how GBV is an intersectional issue that can affect anyone regardless of age,
marital status, or economic class.
• Be able to communicate the health risks and impacts suffered by those living with GBV.

Unpacking GBV
Gender-Based Violence (GBV) Violence Against Women & Girls (VAWG)
Any act perpetrated against a person’s will Any act based on gender norms or unequal power
and is based on gender norms and unequal dynamics that results in, or is likely to result in,
power relationships. It encompasses: physical, sexual, or mental harm to women,
• Threats of violence and coercion including threats, coercion, or arbitrary deprivation
of liberty—whether occurring in public or in
• Physical or sexual assault
private life. It includes:
• Emotional or psychological harm
• Intimate partner violence
• Denial of resources or access to • Sexual assault and rape
services
• Female genital cutting
• Denial of legal self-autonomy
• It inflicts harm on women, girls, men
• Forced marriage
and boys.
• Trafficking
• Denial of education, financial, and legal services

Forms and Manifestations of GBV
PHYSICAL EMOTIONAL/PSYCHOLOGICAL
Hitting, beating, burning, cutting Abuse, Humiliation
Trafficking Confinement/Isolation
Acid attacks, honor killings Intimidation/Threats

Blame for uncontrollable outcomes
SOCIAL
Discrimination, and/or denial of SEXUAL
opportunities
Forced Marriage
Denial of education Sexual Exploitation/Forced Prostitution
Denial of inheritance and/or property Rape*
rights
Harassment
Female Genital Cutting

Reproductive Coercion
A complex form of VAWG that can be perpetrated using physical, sexual,
psychological and/or social violence—most commonly perpetrated through a
combination of these forms.
Examples:
› Repeated shaming and blaming of a woman until she gives birth to a son
› Forcing a women or girl to undergo menstrual regulation to avoid pregnancy
› Throwing away contraceptive pills or condoms
› Using a pin to put holes in condoms
› Denying a women freedom of movement and/or access to resources to access family planning

National GBV Prevalence
VAW in Bangladesh Facts Report on VAW Survey 2015

2017 study | A total 1,143 victims • 72.6 % of ever-married women experienced
§ 63.78% belonged to the age group of 16–30 years, violence by their husband at least once in their
lifetime.
19.16% belonged to the age group of 1– 15 years.
§ 71.91% were married, and 25.63% were unmarried. • 27.8% of women reported lifetime physical
violence by someone other than their husband.
§ 60.37% were housewives, followed by others
(11.46%), students (11.11%) and maid servants • The lifetime rates of emotional and sexual
violence are 28.7% and 27.2%, respectively.
(10.85%).
§ Most of the perpetrators were husbands (64.65%),
followed by the known person (14.00%), neighbors
26 (13.30%), lovers (3.15%), house master and
mistress (2.62%), in-laws and others (2.27%).

UN Special Declaration
Article 1: For the purposes of this Declaration, the term "violence against
women" means any act of gender-based violence that results in, or is likely to
result in, physical, sexual or psychological harm or suffering to women,
including threats of such acts, coercion or arbitrary deprivation of liberty,
whether occurring in public or in private life.
Article 4: States should condemn violence against women and should not
invoke any custom, tradition or religious consideration to avoid their
obligations with respect to its elimination. States should pursue by all
appropriate means and without delay a policy of eliminating violence

National Laws and Commitments
• In 2014, Bangladesh committed to ending child marriage in the country by 2041.

• Multiple facets of the penal code provide for severe punishment in cases of
specific forms of GBV, including acid attacks, femicide to gain new or increased
dowry, and denial of child custody.
• Signatory to international conventions include ICPD and the UN Special
Declaration against Violence against Women.
• Marital rape is exempt from legal prosecution excepting cases where the wife is
below age 13.

GBV Risk Analysis in FP and SRHR

• Identify verbal and non-verbal cues that an FP and SRH client is high risk for current GBV.

LIFE CYCLE
APPROACH

• Denial of access to
education
• Sexual violence
• Restriction on
movement to reach
services
• CEFMU
• Son preference
GBV IN FP AND SRH • Contraceptive sabotage
ACROSS THE LIFE CYCLE • Other repro coercion
• Restriction of
movement
• Coercion to prove
• Intimate partner fertility
violence
• Denial of resources to
access care • Obstetric violence
• Reproductive • Intimate partner violence
coercion • Denial of resources to access care
• Forced repeat pregnancy
• Forced menstrual regulation

GBV Impacts Across the Life Cycle
• Mental health impacts: e.g., depression, anxiety, flashbacks, substance abuse,

suicide ideation
• Sexual and reproductive health impacts: e.g., unintended pregnancy, HIV, STIs,
cervical cancer, miscarriage, pre-term labor, stillbirth
• Physical impacts: e.g., broken bones, contusions, internal bleeding,
malnourishment, death
• Social impacts: e.g., school dropout, unemployment, isolation, limited contribution
to civil society, poverty

Women living with intimate partner violence are:
TWICE as likely 16% more likely

to experience depression to have a low-birth-weight baby
1.5x more likely to acquire chlamydia, gonorrhea, and HIV
38% of all murders of women were committed by their intimate partners
Source: WHO, Caring for women subjected to violence: a WHO curriculum

for training health-care providers, revised edition (Geneva: 2021).

What Can GBV Look Like in FP and SRH?
• A woman in the postpartum ward who waits until her mother-
in-law has gone outside to ask about PPFP
• A FP client who frequently has bruises on her face or wrists Living with GBV is different
when she comes for refill appointments for everyone! Never force a
disclosure. Never assume
• An adolescent girl who doesn’t speak for herself when brought someone is immune to GBV.
by a parent for MR
• A FP client who asks if there are options that her husband
cannot throw away
• An IUD client who returns with her partner soon after insertion
asking for removal

MODULE 2 | SESSION C
Male Engagement in GBV Prevention Awareness

• Clarify concepts around male engagement in GBV prevention awareness, including pros
and cons, challenges and successes, and evidence.

Male Engagement in GBV Prevention
“Engaging men and boys as users, supportive partners,

and agents of change improves health outcomes. More
specifically, engaging men in FP/RH programs has been
successful in decreasing unintended pregnancies,
improving maternal health, reducing sexually transmitted
infections (STIs) and HIV/AIDS, and better meeting the
needs of youth.”
Source: Breakthrough ACTION
INTEGRATING GBV-RESPONSE INTO FP AND RH SERVICE DELIVERY MODULE 2 | SESSION C | SLIDE 41

Potential Role of
Male Engagement to
Improve Women’s FP
and SRHR Status

Benefits of Male Engagement in SRHR
• Male engagement can reduce the spread of STIs, • It provides opportunities for men to promote
HIV and AIDS. better RH, and they can play a role.
• Male engagement can lessen the ill effects of • As individuals, men benefit from intentional
men’s risky sexual behavior on the health of family building and chosen timing and spacing of
women and children. children.
• Men and husband, in most cases, approve of FP. • As family members, men honor their
responsibilities to care for their wives and
• Men make decisions that affect women's and
children by only having children and when safe
men’s health.
and healthy for the family.
• Men can gain awareness that gender affects
• As community leaders and policymakers, men
sexual behavior, reproductive decision-making,
support strong, thriving communities by
and reproductive health.
encouraging intentional FP and health timing
• Male engagement can help meet demands from and spacing of pregnancies.
women for more involvement.

Risks of Male Engagement in SRHR
• Already imbalanced power over fertility and health decisions

• More attention to men in limited resource setting (human
resource, logistics, and client time) can result in unintentional
pulling of resources away from women- and girl-centered
outreach and services.

Key Things to Learn about Involving Men in FP
• Engaging men in FP is a personal issue.
• Check your assumptions.
• Understand power dynamics.
• Own the reality: for better or for worse, men are involved.
• Men are underserved, yet many want to be engaged fathers and
supportive partners.
• Men are FP clients and users in their own right.
• Don’t count men out of health services.
• Providers need to think about social norms too.
• Address men even when they are not present.
• Reach men where they are, through their networks.
• Men can and do participate positively in FP.
• When done right, involving men in FP can yields significant benefits
for women and families.

In Safe Motherhood and SRHR,
Men play many key roles, their decisions and actions make a difference during
• Pregnancy
• Delivery
• Postpartum period

Men: Full Partners and Advocates
for Good Reproductive Health
• Reaching men is a winning strategy. Yes / No
• To encourage sexual responsibility. Yes / No
• To foster men’s support of their partners’ contraceptive choices. Yes / No
• To address the reproductive health care of couples. Yes / No
• Men play dominant roles in decisions. Yes / No
• Men are more interested in family planning than assumed. Yes / No
• Need communication and services directed specifically to them. Yes / No
• Understanding-and influencing-the balance of power is important. Yes / No
• Couples who talk to each other reach better, healthier decisions. Yes / No

MODULE 2 | SESSION D
Understanding GBV in FP and SRH for Adolescents and Youth

• Be able to articulate the risks and impacts of child, early, and forced marriage and unions
(CEFMU) and GBV among young people.
• Understand how national laws impact FP and RH service provision for CEMFU-involved
clients.

Basic Concepts
Adolescent and Youth SRHR and CEFMU
Terms and Definitions Child, Early, and Forced Marriage

Adolescents: 10–19 years and Unions (CEFMU)
Youth: 15–24 years Child and early marriage is any marriage
in which one of the parties involved is
Young People: 10–24 years
below the age of 18. Forced marriage and
unions refer to any union in which one
party did not consent—regardless of their
age. This term includes both formal, legal
marriages, and as well informal union and
cohabitation.
INTEGRATING GBV-RESPONSE INTO FP AND RH SERVICE DELIVERY MODULE 2 | SESSION D | SLIDE 49

Comprehensive SRHR Services for Young People
• Provision of a full range of contraceptive information and supplies,
including emergency contraceptives
• Counseling and information services on FP, pregnancy, and the
prevention and treatment of STIs and RTIs
• Basic equipment for provision of reproductive health services (e.g.: FP,
antenatal care, laboratory testing for STIs/RTIs)
• Services that cater to interrelated issues, such as mental health,
nutrition, sexual abuse, and GBV
• Capacity to accommodate the needs of young people with special needs
• Referral system

Concept of Child Marriage
According to BDHS 2017–18, 71% of women ages 20–49 were married by age 18, and nearly
one-third (31%) of women 20–49 reported that they had married by age 15.
Bangladesh’s Child Marriage Restraint Act, 2017 (CMRA) repealed the earlier British law of
1929. The Act sets the minimum age of marriage for a male as 21 years and for a female as 18
years. This refers to both formal marriages and informal unions in which children under the age
referred with a partner as if married.
To address the child marriage situation of the country, the Honorable Prime Minister of
Bangladesh made the following commitments in July 2014:
• Create a National Plan of Action by the end of 2014 (prepared in 2018);
• Revise the Child Marriage Restraint Act 1929 (revised in 2017);
• End the marriage of under 15-year-olds and reduce by one third child marriage under 18 years by 2021
• Eradicate child marriage from the country by 2041.

Trends (%) of Child Marriage in Bangladesh,
1993–2017
% of Women (20–24 years) First Married by

Exact Age 18: Top Ten Countries

Teenage Childbearing in Bangladesh Drivers of Adolescent Childbearing
• Social stigma and poverty.
• After giving birth, the status of girls’ and boys’
(wife and husband) may improve.
• Lack of girls’ individual identity/
empowerment/agency.
• Barriers to contraceptive access and use
among adolescent girls (unmet needs).
• Misconceptions around contraception.
• Familial and social pressure, and insecurity.
• Presumptions of infidelity and/or extra marital
relationship.

Let’s make a list of the SRHR service needs of adolescents and youth
Type of service needs Most common Sometimes Rare Need GBV as Driver — Y/N
Malnutrition
General health problems (e.g.: viral infection,
bacterial illness, asthma, UTI)
Menstrual problems
Mental health issues (e.g.: depression, anorexia,
sexual identity questions)
Contraception
Emergency contraception & menstrual regulation
Sexually transmitted infection
Addictive behaviors
Physical trauma (e.g: broken bones, contusions,
lacerations)
Sexual abuse and assault response

Case Studies 6–8: Meena, Parvin, and Khadija
To Present in Plenary
• What are the solution points you considered—to handle
the case?

Values Clarification
Vote with Your Feet
• There is no right answer

• Be prepared to share why you have placed yourself where you have
• Power dynamics, values, and beliefs are complicated

Key Takeaways
• Gender is socially constructed and gives everyone habits,
values, biases, and assumptions.
• GBV affects 2 in 3 women in Bangladesh and has significant
impacts on FP and SRH outcomes.
• People from all walks of life and of all ages experience GBV.
• Reproductive coercion is GBV.
• Addressing GBV is something men and women can and
should tackle together.

Questions?

Thank you!
Integrating Gender-Based Violence Response
into Family Planning and Reproductive Health
Service Delivery
—Day 2—
Welcome Back
TODAY’S OBJECTIVES
• Develop foundation skills in GBV-responsive FP and SRH service

provision, disclosure response, and referrals to comprehensive
GBV services.
• Develop knowledge and foundation skills on GBV case recording,
reporting, and referral confirmation.

Module 3
GBV-Responsive FP and SRH Service Provision
GBV-Responsive Counseling in FP and SRH

• The pros and cons of different FP methods for clients living with intimate partner
violence (IPV) and/or reproductive coercion.

Concept of Counseling
• A two-way interaction between a client and a provider.
• An interpersonal, dynamic communication process that involves a kind of
contractual agreement between a client and a counselor who is trained to an
acceptable standard and who is bound by a code of ethics and practice.
• A process of dialogue and mutual interaction between counselor and counselee
aimed at facilitating problem-solving, motivation, and decision-making of the
counselee
• Requires empathy, genuineness, and the absence of any moral or personal
judgment.

Principles of Client-Centered Counseling
• Privacy; ensure audio and visual privacy.
• Take sufficient time.
• Maintain confidentiality.
• Ask the client about their priorities. Listen to their answer.
• Keep it simple; use common language. Avoid overly scientific/technical words.
• First things first: do not cause confusion by giving too much information.
• Say it again; repeat the most important information at the beginning, in the middle,
and the end.
• Use available visual aids, like posters and flip charts, etc.
• Seek feedback from the client.

Counseling with Active Listening
IT IS IMPORTANT TO:
• Use eye contact, as long as this is culturally acceptable in your particular
setting. It shows interest.
• Use open-ended questions. They allow clients to express themselves.
• Check your understanding by summarizing (paraphrasing).
• Nod and use acknowledgment sounds that convey your interest and keep
the conversation flowing, but avoid unnecessarily interrupting your client.
• Use a tone of voice that shows interest.
• Listen for feelings as well as facts.
• Limit active note taking and verbally communicate to the client why you are
writing things down as they speak.

Counseling with Active Listening
DO NOT:
• Interrupt the client unnecessarily.
• Finish the client’s sentences.
• Let your mind wander and spend listening time
formulating your responses or thinking about your
dinner!

GATHER Approach in FP Counseling
• Greet the client respectfully.

G Greet • Ask them about their FP needs. Ask if they have any other concerns
about their health or safety.
A Ask
• Tell them about different contraceptive options and methods,
including information on the FP method’s vulnerability to sabotage
T Tell and degree of partner involvement needed for proper use.
H Help • Help them to make decisions about choices of FP methods.
• Explain and demonstrate how to use the FP methods.
E Explain
• Return, referring, and scheduling an appropriately timed return visit.
R Return Ask the client for their preferred method of follow up communication
and seek consent to send texts or make phone calls. Offer information
on GBV services and referral availability.

Method Pros Cons Discussion Points
• Does not leave any signs on the • With two- and three-month types, • Are you concerned that your
IPV/ skin monthly bleeding often stops after partner may track your periods?
Reproductive Injectable • No supplies to store time • Do you think you could go for
Coercion Contraceptive • Another injection is needed every re-injection visits without fail?
one, two, or three months,
Considerations depending on type
in FP Counseling • Works well for several years • Sometimes can be felt and seen • Are you concerned that your
Adapted from WHO’s • Usually, no follow-up required under the skin of arm partner may track your periods?
Caring for Women Implant • May cause spotting or changes in
Subjected to Violence menstrual bleeding (often improves
curriculum. after three months)
• Remains out of sight in the • Copper IUD often increases • Are you concerned that your
uterus menstrual flow partner may track your periods?
• Copper IUD works well for at • Hormonal IUD can make period • Do you think you may have an
least 12 years; LNG-IUD, for 3–5 lighter or stop STI or are likely to get an STI?
Copper or LNG IUD years • Caution if women has current STI
• Usually, no follow-up required or high STI risk
• No supplies to store • Partner may feel ends of strings in
cervix
• Does not leave any signs on skin • Must be taken every day • Do you have a safe place to
• Little effect on menstrual • Pills/packaging must be kept in keep the pills?
Pill
bleeding safe place

GATHER Skills Practice: Role Plays 1–3

• Did the provider follow client cues to guide discussion and
selection of methods?

• What could the provider have done to make you feel more
comfortable?

Responding to Disclosures of GBV

• Explain the purpose and value of psychological first aid
• Understanding the role of quality disclosure response in FP settings
• Deliver the first three steps of the LIVES approach to first-line response

Responding to Disclosures
As FP providers, you may be the first and/or only person this woman has
been able to tell about what she is dealing with. Your response matters.
Remember:
• It is never the survivor’s fault.
• Everyone deserves to feel and be safe.
• Services and support are available in your district.

LIV(ES)
Listen, Inquire, Validate, Enhance safety, and Support
The LIV(ES) pneumonic was developed by the World Health Organization to ensure first line response to
violence against women in primary and preventative health care settings.
• Listen – Listen closely with empathy, no judgment.

• Inquire – Assess and respond to the client’s needs and concerns – emotional, physical, social, and practical.
• Validate – Show the client you believe and understand them.
Psychological First Aid
• Enhance Safety – Discuss how to protect the client from further harm.
• Support – Help connect the client to appropriate resources and services, including social support.

LIV(ES) Step Sample Phrases to Use
• I hear you.
L - Listen • I’m listening.
• We have time if you there is anything else you want to tell me.
• What can I do to help?

I - Inquire • Are you worried about your safety if you tell your partner?
• How are you feeling? Are you in pain?
• That must have been very difficult.

• I’m so sorry this happened to you
V - Validate • You did not/do not deserve this
• Thank you for telling me.
• Sadly, this happens to many women. You are not alone.

LIV(ES) Skills Practice: Role Plays 4–6

Risk Identification
The following may be signs that your client is in immediate danger. Should you
see these signs or behaviors, you may wish to fetch a GBV specialist colleague
and have them join you in the appointment room:
• The client tells you she is afraid she will be killed if she returns home.
• A client is accompanied by a partner or family member and not allowed to
answer questions for themselves.
• A child under 13 is seeking MR or emergency contraception.

MODULE 3 | SESSION C
Making GBV Referrals

• Know when and how to provide referrals for comprehensive first line response to GBV

Effective Referral Pathway
Case Management Referral System
First Point of Entry

• Receives client
• Documents service Caseworker
• Refers client to other needed • Establishes partnership with client
services • Identifies client needs
• Refers client for services and
documents referral
• Follows up with client
Health Facility • Advocates for client to meet needs
cross continuum of care
• Diagnoses client
• Provides medical treatment
• Refers to caseworker

• What are the steps you will follow to counsel her

in a real situation?
• In what way you will support the case so she can
continue her pregnancy?
• What kinds of referrals might you want to make
for this case?

One-Stop Crisis Cell
Services of OCC at MCHs

• Medical treatment
• Social reintegration
• Safe custody/shelter home
• Rehabilitation
• Psychosocial counseling
• Social welfare services
• Legal support
• Police assistance
• Forensic DNA test

National Helpline Center as a Referral Way Out
National Helpline Center for VAWC
Victims 109 Receiver

Witnesses 1. Place of occurrence
Informants 2. Incidence in brief
3. Nature of support required
For possible and immediate support Follow up

UNO/UWAO/NGO/UPC/OC/Others for result
Connect to professionals
• Doctor • Counselor Database system
• Nurse • DNA expert
• Police • Informants
• Lawyer

Important GBV Referral Centre Locations in Bangladesh
One-Stop Crisis Center at MCH

One-Stop Crisis Cell at District
One-Stop Crisis Cell at Upazila
National Trauma Counseling Center (NTCC)
National Forensic DNA Profiling Laboratory
National Helpline Center for Violence
Against Women and Children
Regional Trauma Counseling Center (NTCC)

Helplines for the Prevention GBV (VAW) and Child Marriage

Where to Report
There are several places where we can report:
• One-Stop Crisis Center
• Trauma Counseling Center
• Forensic DNA Laboratory
• National Help Line for Violence Against Women
• Legal Aid Center
• Legal Action Center/Police Station
• Social Support Center/rehabilitation center
• Safe Custody/Shelter Home
• Rehabilitation Center

National Trauma Counseling Center (NTCC)
Objective of NTCC Psychosocial Counseling Services

• Provide psychosocial counseling support in NTCC provides psychosocial counseling support
NTCC, OCC, and safe home to those for those experience VAWC free of cost. NTCC
experiencing violence against women and provides a wide range of counseling support
children. including:
• Conduct different types psychosocial • Individual face-to-face counseling
counseling training for Human Resource
Development. • Individual tele-counseling
• Organize awareness-raising program for • Couple counseling
changing mindsets. • Family counseling
• Establish a strong network among
organizations/stakeholders who work on
GBV issues. • Online Counseling

Intra-Facility versus Inter-Facility Referral
Intra-Facility Inter-Facility
Facility has an emergency department, GBV Client has need and desire for full case
specialist, and/or other needed services. management and the full scope of an OCC cell.
Client has declined legal referral and is seeking FP service facility does not house:
medical aid only.
• GBV subject matter expert
• Necessary equipment and/or commodities
for treatment
• Capacity to protect confidentiality of the
client

Role Play 7: Web of Referrals
Let’s better understand and gain empathy for how

uncoordinated systems and too much specialization can
make referrals burdensome for a survivor of GBV.

Forms and Formats of GBV Recording and Reporting

Lovely Begum (pseudonym) is only 16 years old. Her parents had arranged to have her married
to a nearby acquaintance when she turns 18, but a jealous cousin abducted her and forced her
into wedlock. She tried to escape to her parents’ home after that the cousin made her isolated
from everyone in the family, but her parents explained that because the marriage had been
consummated, her previous betrothed will not take her anymore and told her she needed to
go back to her husband.
Lovely returns to her husband’s house. Her husband continues to keep her at home and does
not allow her to visit her parents anymore. He is angry that she tried to stay at her parents. He
yells at Lovely and beats her frequently. He accuses Lovely of not getting pregnant on purpose.
Finally, after six months of life as a wife, Lovely discovers she is pregnant and goes to the SRH
service center to get help for continuing her pregnancy. She is very worried about protecting
her precious child in her womb and concerned that the beatings she is receiving at home will
harm her child

Module 4
Foundational Knowledge of GBV Case
Recording, Documentation, and Record
Keeping
Legality, Protecting Confidentiality, and Reporting GBV

• Gain an understanding of the legality and reporting aspect of a GBV case
identification, notification to primary management and referral

Defining “Legality”
Legality is an act, agreement, or contract that is consistent with the

law or state of being lawful or unlawful in a given jurisdiction, and
the construct of power. Legal assistance describes a range of legal
services, from the provision of generic legal information and advice
to representation by a legal professional in court.

Legal Considerations for FP and SRH Providers Around GBV
• Health care providers do not have a legal mandate to report GBV. You should
only report cases to judicial authorities if and with a client’s written consent.
• Documentation of disclosure, injuries, or other medical records may become
evidence in the event a survivor chooses to file a legal complaint and
prosecution follows.
• Universal provision of referral options and GBV services available is not legally
required but is ethically mandated.

Integrating GBV Disclosure and Response Reporting
into an FP and SRH Visit
What to Include in Your Report
• Basic demographic information • Use separate forms provided. GBV
• Consents obtained disclosures should NOT be noted in the
• History regular FP register.
• Account of the assault
• Results of the physical examination • Immediately following the visit, place
• Tests and results your documentation form in an
• Treatment plan medication provided or
assigned, locked storage space.
prescribed
• Referrals provided • Document in three places: confidential
• Anonymous code for use in referral client record, referral slip, and
communication
• Information shared by client anonymized facility log.
• Provider observations

Facility Registers for Recording Cases of GBV

Case Study 10: Aklima
Using the sample referral and GBV record forms, fill out the
documentation needed based on the information from Aklima’s story.
For Reflection and Group Discussion

• What was the hardest pieces of the form to complete?
• Do you think you will be able to do this during a normal day of work?
• Do you have any questions on how to fill out a certain portion of the
forms?

Module 5
Closing
Key Messages
üFP/SRH providers have a critical role to play in first line response for violence
against women and girls.
üBasic services such as GBV-responsive FP method counseling, psychological first
aid, and appropriate activation of a referral chain can have significant impact on
the trajectory of care for people living with GBV.
üFP/SRH providers have a significant role to play in safe, confidential reporting,
and documentation of GBV prevalence and incidence.

Wrap Up
You have three final steps in this training:

1) Complete your individual action plan
2) Take the post-test
3) Meet with a trainer for clinical competency
assessment

Questions?

Thank you!

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Integrating Gender-

Based Violence Response

Integrating Gender-Based Violence

MODULE 0: INTRODUCTION TO TRAINING .............................................................................................................................23

MODULE 1: UNDERSTANDING GENDER AND GBV ..................................................................................................................32

MODULE 1 TOOLS AND HANDOUTS .......................................................................................................................................52

MODULE 2: FOUNDATIONS IN GBV ........................................................................................................................................57

MODULE 3: GBV-RESPONSIVE FP AND SRH SERVICE PROVISION.............................................................................................89

MODULE 3 TOOLS AND HANDOUTS ..................................................................................................................................... 114

MODULE 5: CLOSING ............................................................................................................................................................ 134

MODULE 5 TOOLS AND HANDOUTS ..................................................................................................................................... 138

REFERENCES ......................................................................................................................................................................... 143

At the Nairobi Summit (ICPD+25) in 2019, the Government of

Bangladesh, and Rockville, Maryland, USA: NIPORT and ICF, 2023).

Shahan Ara Banu, ndc

Md. Sohel Parves

Md. Mahbub Ul Alam

Content Development, Editorial, and Production Support

Acronyms and Abbreviations

and Rockville, Maryland, USA: 2019).

Suggestions for Using This Manual

Organization of the Manual and Training

TOTAL SESSION/MODULE TIME

FOR GROUP DISCUSSION

Guidance on Facilitating Discussion of GBV Issues

Setting Ground Rules for GBV Discussions

P COMPLETE THE FOLLOWING BEFORE STARTING EACH MODULE

Prepare for each of the exercises according to the Trainer’s Instructions.

Obtain or develop and organize the materials needed.

Have a plan for monitoring time and keeping to the schedule.

Have a plan for coping with difficult or disruptive participants.

Key Principles of Adult Learning Theory14

DOs and DON’Ts of Training

The Training Cycle

For effective training, remember the following:

Tips for Training as a Team

MODULE 0: Introduction to Training

MODULE 3: GBV-Responsive FP and SRH Service Provision

Module 0: Introduction to Training

TOTAL MODULE TIME: 30 MIN.

Session 0-A: Introductions, Group Norms, and Pre-test

Prepare the training room as follows:

Module 0 Tools and Handouts

Women should do all the cooking

Men are natural leaders

Women can get pregnant

SCORE: /18 POINTS

Tool B: Pre- and Post-Test Answer Key

Women should do all the cooking X

Men are natural leaders X

Women can get pregnant X

SCORE: /18 POINTS

Module 1: Understanding Gender and GBV

Session 1-A: Understanding Gender in FP Services

Activity 1: Presentation and Reflection

Socially constructed roles, responsibilities, and Physically, biologically defined

Differences in dress and behavior Determine our physical functions

Changeable over time Generally unchangeable

From USAID, Interagency Gender Working Group (IGWG):19

Definitions from Pathfinder International:20

Gender-Based Violence (GBV)

When presenting SLIDE 14, emphasize the following to participants:

REFERENCE: GENDER EQUALITY VS GENDER EQUITY